Diagnostic sensitivity of different techniques in the diagnosis of lung tumors with the flexible fiberoptic bronchoscope. Comparison of brush biopsy, imprint cytology of forceps biopsy, and histology of forceps biopsy

Abstract

Brush and forceps biopsies were done consecutively in 186 cases of pulmonary neoplasia with a flexible fiberoptic bronchoscope guided by x-ray television fluoroscopy. Imprint and histologic sections were prepared from all forceps biopsy specimens. The three techniques were compared for their diagnostic sensitivity. As a result 84.9% of all imprints, 80.6% of brush biopsy specimens, and 62.9% of histologic sections were positive for malignancy. The sensitivity of brush biopsy specimens was independent of the location and morphology of the tumors, but the sensitivity of forceps biopsy specimens was lower in neoplasms unidentified by bronchoscopy. The sensitivity of the diagnostic accuracy when all three methods were used jointly was 97.3%, and the specificity was 100%. Agreement in the final morphologic tumor type was found in 130 of 150 cases (86.7%) by positive brush biopsy specimens, in 136 of 158 cases (86.1%) by positive imprint cytology, and in 104 of 117 cases (88.9%) by positive histology from forceps biopsy specimens. For routine bronchoscopy, all three methods should be used in combination to obtain the highest diagnostic yield.

Comparison of bronchial biopsy, broncho alveolar lavage (BAL), brush cytology and imprint cytology in suspected cases of lung cancer

“…Though the histological diagnosis of lung cancer from these specimens is considered definitive it is useful to have an earlier indication as o the presence of malignancy and the cytomorphological analysis of touch imprint smears made from core biopsies of the lesions might advance this 9 .…”

The Importance of Bronchoscopy in Early Lung Cancer (LC) Diagnosis

“…The procedure has reduced diagnostic contribution (may increase after bronchial lavage and bronchial brush by increasing the number of exfoliated cells). The major cause of false positives in this case is signifi ed by pavement metaplasia [5].…”

“…This procedure har a signifi cant higher output than bronchial aspirate (positive results in 88-94% of cases) [5].…”

“…This procedure off ers histological confi rmation of tumors highlighted by bronchoscopy: 55-85%, but it has a major complication -bleeding [5].…”

Clinical application of immunocytochemical detection of ALK rearrangement on cytology slides for detection or screening of lung adenocarcinoma

“…because of difficulty to approach a tumor by TBLB, TBLB often fails to obtain tumor tissues whereas tumor cells are contained in cytology specimens. Practically, since positive rate of tumor cells in cytology specimens has been shown to be higher than that in TBLB specimens [12,13], a final diagnosis is often made by cytology specimens.…”