Evaluation of the diagnostic accuracy of bronchial brushing cytology in lung cancer: A meta-analysis.

BACKGROUND: Flexible bronchoscopy is commonly used to examine patients suspected to have lung cancer. Bronchial brushing is one of the cytological technologies for lung specimens obtained through a bronchoscope. However, the accuracy of bronchial brushing cytology (BBC) for lung cancer diagnosis is still inconclusive. The aim of this study was to evaluate the diagnostic accuracy of BBC. METHODS: A literature search was conducted with PubMed, Embase, the Cochrane Library, Web of Science, Biomed Central, Clinical Key, and ClinicalTrials.gov. Studies that assessed the efficacy of BBC in detecting lung cancer were included. Articles that estimated the accuracy on a per-patient basis were included. Review articles, case reports, and research that provided insufficient data to construct a 2 × 2 table were excluded. Both prospective trials and retrospective studies were included. English language studies were reviewed. Data synthesis was performed with a random-effects model. RESULTS: Seventeen studies with 2538 patients were included in the study. The meta-analysis for BBC generated a pooled sensitivity of 0.67 (95% confidence interval [CI], 0.65-0.70) and a pooled specificity of 0.91 (95% CI, 0.89-0.93). The pooled diagnostic odds ratio for BBC was 24.55 (95% CI, 12.39-48.66). The subgroup analysis for studies using liquid-based cytology (LBC) generated a pooled sensitivity of 0.68 and a pooled specificity of 0.92. The pooled diagnostic odds ratio of studies using LBC was 114.18. CONCLUSIONS: These findings indicate that BBC is a discriminative diagnostic approach with moderate sensitivity and high specificity for diagnosing peripheral pulmonary lesions. BBC using LBC has higher diagnostic performance.

Mycobacterium tuberculosis diagnosed promptly by bronchial brushing cytology in an immunocompetent patient.

Respiratory cytology plays an important role in the diagnosis of lower respiratory tract infection. The timely diagnosis of pulmonary tuberculosis (TB) can be very challenging due to the nonspecific cytomorphologic features and limited number of organisms, especially in the immunocompetent patients. Here, we reported a case of TB diagnosed promptly by bronchial brushing cytology in a 51-year-old immunocompetent patient. She presented with a 4 cm fungating lesion involving right lower lobe of the lung and mediastinal lymphadenopathy with an initial concern for malignancy. Bronchial brushing showed scattered acute inflammatory cells in the background of necrosis. A cell block was prepared and acid-fast bacilli (AFB)-positive organisms were identified. Subsequent polymerase chain reaction (PCR) performed on the sputum detected Mycobacterium tuberculosis. This case highlights the importance of recognizing the cytomorphology of TB from a bronchial brushing specimen; and also emphasizes the potential utility of the cell block from respiratory cytology in the diagnosis of TB.

[Fluorescence in situ hybridization combined with cytomorphology for the detection of lung cancer in bronchial brushing specimens].

Objective: To evaluate the diagnostic value of fluorescence in situ hybridization (FISH) combined with bronchial brushing cytology for detecting lung cancer. Methods: Centromeric enumeration probes (CEPs) for chromosomes 7, 8 and 17 were used in FISH assay. The combination of FISH and cytology was analyzed in 69 bronchial brushing specimens. Results: The positive rates of CEP7, CEP8 and CEP17 in malignant cases diagnosed by cytology were 50.0%, 80.8% and 65.4%, respectively. CEP8 probe showed significantly higher positive rate than CEP7 (P=0.015). In the samples of suspicious of malignancy, the positive rates of CEP7, CEP8 and CEP17 were 46.6%, 66.7% and 58.8%, respectively. While in atypical cases, the positive rates of these three probes were 20.0%, 33.3% and 25.0%, respectively. There was no statistical difference between suspicious of malignancy and atypical cases (P>0.05) as well as between malignant and suspicious of malignancy (P>0.05). No chromosome aberrations were found in normal cases diagnosed by cytology. The positive rates of these three probes in adenocarcinoma (ADC) were slightly higher than those in squamous cell carcinoma and small cell lung cancer. However, only CEP8 probe showed statistically difference between ADC and small cell lung cancer (P=0.044). The combination of cytology and FISH using any one of the three-probe set (CEP7, CEP8 and CEP17) showed the sensitivity and specificity of 80.3% and 100.0%, while those of cytology were 54.1% and 100.0%, respectively. Conclusions: FISH combined with cytomorphology assisted the cytology diagnosis of suspicious of malignancy and atypical cases. Therefore, it significantly improved the diagnostic sensitivity for lung cancer without sacrificing specificity.

Usefulness of endobronchial ultrasound (EBUS) in the diagnosis of peripheral pulmonary lesions in a general hospital.

AIM: To investigate the efficiency of guided bronchoscopy compared to blind techniques in the study of non-visible pulmonary lesions. MATERIALS AND METHODS: A one-year, retrospective, study was conducted comparing two populations: Biopsies were either performed conventionally (FB-B) with the help of static images and the second where biopsies were performed after guidance (FB-EBUS). A 20-MHz radial-type ultrasound probe was used to obtain images. Sampling techniques, like bronchial brushing and transbronchial biopsies, were conducted in both populations by two separate bronchoscopists. If diagnosis was not achieved a surgical biopsy or observation followed. RESULTS: Forty patients appeared with non-visible lesions and were included in this study. Twenty were examined with the use of FB-EBUS and in 20 cases FB-B was conducted. At the FB-EBUS population a pathologic lesion was visualized in 16 cases (80%) and in 15 cases (75%) a diagnosis was achieved. All lesions that weren't visualized had a diameter less than 30 mm. At the FB-B population a diagnosis was achieved in 11 cases (55%). In pulmonary lesions with a diameter more than 30 mm, the diagnostic yield was 87, 5% using guidance and 61, 5% using FB-B and in lesions less than 30 mm 66, 67% and 42, 85% respectively. Moreover, left lower lobe was the most promising to obtain a diagnosis. CONCLUSION: Our results suggest that in patients with a non-visible pulmonary lesion a diagnostic strategy involving the choice of EBUS-guided biopsy is a reasonable and effective choice.