Respiratory cytology in malignant lung disease – The thoracic oncologist’s perspective

Abstract

Respiratory cytology continues to play a central role in the diagnosis and staging of thoracic malignancy, although over time indications have changed. Historically, sputum cytology and endobronchial brushings and washings figured prominently, but with the advent of endobronchial and endoscopic ultrasound much greater emphasis is placed on fine needle aspirates from lymph nodes. The advent of targeted sequencing panels for genomic profiling to identify driver mutations and PD‐L1 directed immunotherapy means that there is a need to extract increasing amounts of diagnostic and predictive information from ever smaller amounts of diagnostic material. Recent work has demonstrated that cytology samples are well suited to delivering the information required, but in order to understand the limitations of clinical and laboratory techniques, a close working relationship between pathologist and thoracic oncologist is needed to optimise sample procurement and utilisation.

Evaluation of pleural fluid cytology for the diagnosis of malignant pleural effusion: a retrospective cohort study

“…A fluid volume of 50–99 mL was associated with increased sensitivity on bivariate analysis in our study, but was not included in multivariate analysis. This is broadly in keeping with existing literature and protocols that indicate sampling at least 50 mL of pleural fluid 13–15 optimises sensitivity, but collecting larger volumes beyond 50 mL does not necessarily increase yield 16 . It might be that improvement in overall sensitivity could be obtained with stricter adherence to pleural fluid volume recommendations.…”

“…This is broadly in keeping with existing literature and protocols that indicate sampling at least 50 mL of pleural fluid [13][14][15] optimises sensitivity, but collecting larger volumes beyond 50 mL does not necessarily increase yield. 16 It might be that improvement in overall sensitivity could be obtained with stricter adherence to pleural fluid volume recommendations. It also serves as a reminder of the importance of regular audit of pleural procedures to ensure an adequate sample volume.…”

Comprehensive characterization reveals sputum supernatant as a valuable alternative liquid biopsy for genome profiling in advanced non-small cell lung cancer

“…In addition to histopathologic work-up, sputum cytology has been an long-established approach for lung cancer diagnosis and staging [10]. The study on PCRbased EGFR genotyping categorized samples into three groups based on cytologic evaluation of the precipitates after cfDNA extraction [5,11] and found significantly improved sensitivity for detecting EGFR mutations from SPU with accompanying malignant cells-positive precipitates compared with the other subgroups (100% vs. 71.4% and 0% in the other two groups) [5].…”

How cytology and cytology-based HPV testing could assist clinicians in the diagnosis of head and neck squamous cell carcinoma

“…Cytologic examination via different methods has always been an important modality for diagnostic and predictive testing of cancer patients. In particular, for lung cancer, many cytology sampling techniques, such as brushing, washing and ne needle aspiration (FNA), have been applied for decades in clinical practice [4,5,6]. In recent years, FNA has been performed for suspicious cervical neck metastasis in HNSCC patients and has been recommended by the latest National Comprehensive Cancer Network (NCCN) guidelines for head and neck cancers [7].…”