Diagnostic accuracy of cytology and biopsy in primary bronchial carcinoma.

Abstract

SUMMARY The accuracy of diagnosis in 656 patients with the four common histopathological types of primary lung cancer has been assessed by comparing the cell type diagnosis made on cytological and histological investigation with that determined by examination of the surgically resected or necropsy specimen. The accuracy of diagnosis achieved by cytological examination of sputum and bronchial aspirate, and by bronchial biopsy histology was over 85%. The least accurate diagnostic procedure was percutaneous needle biopsy (62%). Squamous and small cell tumours were accurately diagnosed by all four investigations but errors were made in the diagnosis of large cell and adenocarcinomas. Nearly half the number of patients (43%) with large cell carcinoma were later reclassified as having squamous carcinoma and of the patients with adenocarcinoma 32% had been predicted to be squamous and 18% large cell carcinoma. We consider such quality control of pretreatment diagnosis mandatory in management of individual patients and before enrolment in clinical trials.In 1979 a study was reported from Papworth Hospital, Cambridge which examined the accuracy of diagnosis of cell type in patients with primary lung cancer.' The presumptive cell type as predicted by cytology and biopsy techniques was compared with the true histological cell type as determined by histological examination of tumour tissue obtained at surgical resection or necropsy. The results indicated that the true cell type was most accurately predicted by sputum cytology (88 Y.), closely followed by bronchial aspiration (84%) and bronchial biopsy (80 %). The least accurate procedure was percutaneous needle biopsy (48 %). Diagnostic accuracy was highest in patients with squamous cell carcinoma while particular difficulty was experienced in diagnosis of patients with adenocarcinoma.Inevitably, with such a study limited to a four-year period in a single hospital, the number of patients in each histological group was relatively small. We have therefore undertaken a larger study of 673 patients with confirmed lung cancer seen at two centres, Papworth Hospital, Cambridge and Brompton Hospital, London and this includes the results of the original work from Papworth.

Outcome of bronchoscopic biopsies in the University of Benin Teaching Hospital

“…This coincides with the approved guidelines by the British Thoracic Society (BTS) as bronchoscopy is an important tool for resolving the diagnostic problem 5. Lung tumour was an important differential in all the patients in the study.…”

“…Biopsy obtained from sites of extrinsic bronchial impression have a smaller yield of about 25% as against >75% for directly visualised bronchial lesions 357. All three patients with adenocarcinoma had unrepresentative biopsy specimens, which diagnosis was only confirmed either at thoracotomy or transthoracic lung and pleural biopsy.…”

“…Lung tumour was an important differential in all the patients in the study. Biopsy, in these instances, provides tissue specimens for histological diagnosis 56. Lesions found on chest radiographs formed the main reason for referral for bronchoscopy.…”

Utility of Rapid On-Site Evaluation of Transbronchial Needle Aspirates

“…For further management in bronchogenic carcinoma the accurate distinction of SCLC from NSCLC is of utmost importance. TBNA is the most sensitive sampling method for SCLC [20,21,22,23], while forceps biopsies are prone to crush artefacts and sometimes difficult to interpret [24]. The subclassification of NSCLC is less important for routine clinical practice and can be challenging on bronchoscopic specimens in general [4, 21, 25].…”

Cell type accuracy of transthoracic fine needle aspiration material in primary lung cancer

“…1,5 Determining the cancer cell type preoperatively is not without error. [10][11][12][13] pathologist. The following characteristics were recorded in each patient: sex, age, guidance of the TFNA, diameter of the tumour, location of the tumour, tumour type, the degree of tumour differentiation and stage of the tumour.…”