Cytology of bronchial biopsy rinse fluid to improve the diagnostic yield for lung cancer

Abstract

Sampling techniques are combined during bronchoscopy to increase the diagnostic yield for endobronchial malignant tumours. Bronchial biopsy provides the definitive histological diagnosis in most cases, but accompanying cytological procedures such as washing, brushing, needle aspiration or imprint cytology can increase diagnostic yield. In this prospective study, a different cytological technique, that could enhance the diagnostic yield of bronchoscopy without increasing its time or cost, was tested. Flexible bronchoscopy was performed in 93 patients suspected of having pulmonary neoplasms. Bronchial biopsies were initially placed in a balanced salt solution. When bronchoscopy was finished, all visible tissue fragments were removed and placed in formalin to undergo histopathological examination and the rinse fluid was sent for cytological examination. Washing was performed routinely but no cytological brushing was employed. Eighty-two patients had final diagnoses of malignant neoplasm. In four (4.8%) of these patients, the only positive result came from the cytological examination of the bronchial biopsy rinse fluid. No false-positive results were found. The agreement with the histological results was 81.8%. The addition of bronchial biopsy rinse-fluid examination increased the sensitivity of bronchoscopy from 65.8% to 70.7% (McNemar's p=0.009). The cytological study of bronchial biopsy rinse fluid offers reliable positive results in an additional 4.8% of cases, thus enhancing bronchoscopic diagnostic yield for malignant endobronchial tumours while neither prolonging the procedure nor increasing costs.

The state of cell block variation and satisfaction in the era of molecular diagnostics and personalized medicine

“…[17] Despite the numerous advantages of CBs, the cellular yield of CBs is inconsistent and varies widely. [181920]…”

Evaluation of various cytological examinations by bronchoscopy in the diagnosis of peripheral lung cancer

“…Nevertheless, these techniques were not analysed separately, so no conclusive results could be obtained from Zavala's report. Cytological examination of the rinse fluid of biopsy specimens had not been mentioned again until 1998, when Rosell et al (1998) evaluated the effectiveness of this technique. They reported that this technique increased the diagnostic sensitivity of lung cancer from 65.8 to 70.7% (P ¼ 0.009).…”

“…The cytological examination of the brushing samples or bronchial washing fluid in addition to the histological examination of specimens obtained by forceps biopsy has been shown to increase sensitivity in the diagnosis of peripheral lung tumour, by an estimated 12 -30% (Chaudhary et al, 1978;Mak et al, 1990;Govert et al, 1996). Furthermore, cytology on the rinse fluids has been previously reported to elevate the diagnostic sensitivity from 65.8 to 70.7% (Zavala, 1975;Rosell et al, 1998). On the basis of these results, we planned to evaluate the effects of a histological examination combined with cytological techniques such as imprints of biopsy specimens and cytology on the rinse fluids of the forceps and brush; the effects of such combinations have not been previously reported.…”

Improvement of cellularity on cell block preparations using the so‐called tissue coagulum clot method during endobronchial ultrasound‐guided transbronchial fine‐needle aspiration

“…The commonly used method of CB preparation is to rinse the aspiration needle with normal saline, spin down and collect the material, and then process the pellet in the laboratory 24‐27. Our experience, and that of others, has shown that a variable amount of material and/or tissue is recovered using this conventional method, and the efficiency of this method for obtaining adequate tissue samples is limited 23‐27.…”