Accuracy of morphological diagnosis of lung cancer in a department of respiratory medicine.

Cytology-based treatment decision in primary lung cancer: Is it accurate enough?

“…This has been previously reported [6,7,10], mainly in the absence of endoluminal lesions, or when only infiltrative or compressive mucosal changes are seen endoscopically [27]. False positive cytological results are rare, in the order of 0-1.4% [7,9,28,29]; this is an important concept since, due to lack of surgical tissue for most of our patients, we could not assess the positive predictive value (PPV) of these cytologically positive but biopsy-negative specimens.…”

“…On the other hand, relying solely on cytologically confirmed diagnoses is controversial. Incorrectly diagnosed SCLC on cytology, although uncommon (0-8% of cases) [5,6], has occurred in 1/11 (9%) of our subjects. However, medical history including smoking status and occupational exposure, physical examination with careful assessment of paraneoplastic signs, and radiological appearance might assist the clinician in evaluating the PPV of cytology-confirmed SCLC.…”

“…According to previous findings, false negative results on cytology ranged from 5% to 65% [5][6][7]9,10,[14][15][16][17]19]. This wide variability in cytological yield among studies can be related to several factors, such as size of the study population, the cytological procedure being employed, and quality of specimens, location and size of the lung tumour, endoscopic findings, as well as the investigational procedure regarded as the reference standard.…”

“…Cytological procedures are often employed, as they are less invasive and easier to perform, but their accuracy with regard to lung cancer cell type has been previously questioned [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Payne et al have reported an overall diagnostic accuracy achieved by sputum cytology, bronchial aspirates, and bronchial biopsies of 89%, 86% and 92%, respectively, when compared to histology of resected tumour or necropsy specimen.…”

“…Similar studies have shown diagnostic accuracy in the range of 56-87% for bronchial brushings, 48-84% for bronchial aspirates, and 35-79% for sputum specimens. Again, diagnostic accuracy on cytology was highest for SqCC and SCLC, lower for ADC, and poor for NSCLC-NOS [6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”