Sequential use of bronchial aspirates, biopsies and washings in the preoperative management of lung cancers

Abstract

BackgroundThe combination of cytology and biopsies improves the recognition and typing of small cell (SCLC) versus non small cell (NSCLC) lung cancers in the fiberoptic bronchoscopy assessment of centrally located tumours.MethodsWe studied whether bronchial aspirates performed before biopsies (BA) and washings performed after biopsies (BW) could increase the diagnostic yield of fiberoptic bronchoscopy. A series of 334 consecutive samples taken in patients with suspicious fiberoptic bronchoscopy findings was studied. Two hundred primary tumours were included in the study. The actual diagnosis was based on surgical tissue specimen analysis and/or imaging techniques. The typing used was that of the 1999 WHO/IASLC classification.ResultsThe diagnosis of malignancy and tumour typing were analyzed according to the sequential (combined) or single use of tests. Malignancy was assessed by cytology in 144/164 (87.8%) positive biopsy cases and in 174/200 tumour cases (87.0%). BA before biopsies allowed 84.0% of cancers to be diagnosed, whereas BW after biopsies allowed 79.0% of cancers to be found (p = ns). However, combining biopsies with BW allowed 94.0% of cancers to be diagnosed, whereas 82.0% were diagnosed by biopsies alone (p < 0.001). The highest diagnostic yield was obtained with the combination of BA, biopsies and BW, with 97.0% sensitivity. Exact concordance in typing was obtained in 83.8% of cases. The six surgically resected cases (3.0%) with negative cytology and biopsy results included four squamous cell carcinomas with necrotizing or fibrous surface and two adenocarcinomas, pT1 stage.ConclusionFiberoptic bronchoscopy may reach a yield of close to 100% in the diagnosis and typing of centrally located, primary lung cancers by combining bronchial aspirates, biopsies and washings.

Value of cytologic analysis of bronchial washings in lung cancer on the basis of bronchoscopic appearance

“…The diagnostic yield of forceps biopsy in the present study was 80.5%, which was similar to the results of previous studies (3,6,16,18,23), and bronchial washing had a positive diagnosis rate of 37.8%. Most previous studies reported a similar positive diagnosis rate for cytologic analysis of bronchial washing (27%-49%) (3,5,15,18).…”

“…These patients accounted for 3.6% of all patients and 18.4% of bronchoscopic biopsy-negative patients. Previous studies have reported positive diagnosis rates of 2.1%-9.5% based on cytologic analysis only (3,4,7,15,23,27). Histologic type did not affect the positive diagnosis rate of washing cytologic analysis in these cases.…”

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

“…Similar results were reported by other studies which concluded that for endoscopically visible tumors, the diagnostic yield of BW does not differ whether performed before or after BB and biopsy. [228232233234] However, a prospective randomized trial by Hou et al . [235] concluded that in endobronchial exophytic tumors, prebiopsy brushing appears to be superior to postbiopsy brushing.…”

“…Similarly, Piaton et al . [232] concluded that the yield of fiberoptic bronchoscopy may reach close to 100% in the diagnosis and typing of centrally located, primary lung cancers by combining biopsies and pre–post-BW. These results have been supported by other studies as well.…”

Diagnosis and Predictive Molecular Analysis of Non–Small-Cell Lung Cancer in the Africa-Middle East Region: Challenges and Strategies for Improvement

“…Bronchial washing can be performed prior to or following biopsy sampling [38,39]. It is recommended that as much volume of washings as possible should be recovered after instilling 20-30 ml of isotonic saline [39,40].…”