Papers

Prospective study of combined use of bronchial aspirates and biopsy specimens in diagnosis and typing of centrally located lung tumours

Clinical Cytopathology Laboratory, Lyon Grange-Blanche Medicine Faculty, Domaine Rockefeller, 69373 Lyons, France E Piaton, pathologist M-H Grillet-Ravigneaux, statistician H Pellet, professor of histology. Internal Medicine Unit, General Hospital, BP 364, 39016 Lons-Le-Saunier, France B Saugier, oncologist. Correspondence to: Dr E Piaton, Laboratoire d'Histologie, Faculte de Medecine, Lyon Grange-Blanche, 8 avenue Rockefeller, 69373 Lyons, Cedex 08, France.

Abstract

Objective: To determine the diagnostic accuracy of examining bronchial secretions in pulmonary cytopathology and whether cytology and histopathology can complement each other in routine practice among lung specialists.
Design: A prospective study comparing 1225 cytological and biopsy results, conducted during 1987-93. Tumours were confirmed by histopathology, imaging techniques, or clinical outcome and imaging techniques combined.
Setting: 11 lung or internal medicine units, France.
Subjects: 1128 patients (874 men; 254 women) aged 65.3 (SD 13.7) years who underwent fibreoptic bronchoscopy for various pulmonary symptoms.
Results: Exact concordance between cytological and biopsy results was obtained in 1036/1187 (87.3%) satisfactory specimens. In all 574 lung tumours were diagnosed. One case (0.08%) was a false positive cytological diagnosis in a patient with tuberculosis. Patients with lung cancer were more likely to have positive cytological results than positive biopsy results (P<0.001). Agreement in tumour typing was observed in 375/424 (88.4%) cases, when non-small cell carcinomas, small cell carcinomas and undifferentiated carcinomas were separated. In the 11 patients with squamous cell carcinomas in situ, eight (72.7%) of the carcinomas were diagnosed cytologically as squamous cell. Unsatisfactory material was obtained in only 20 (1.6%) and 19 (1.6%) cases by cytology and biopsy respectively. Examinations had to be repeated in 86 (7.6%) patients.
Conclusions: Examination of bronchial secretions complements histopathology in both diagnosing and typing lung tumours and could be performed more systematically in patients undergoing fibreoptic bronchoscopy.

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