PURPOSE: To evaluate the relative interspecimen diagnostic contribution of various cytological samples in the identification of histologic type in patients eventually diagnosed with primary lung cancer.
METHODS: We studied 74 patients (50 male & 24 female) aged 63±8.9 yrs. (mean±SD)diagnosed with primary lung cancer. Diagnosis was established by either bronchoscopic or surgical biopsy. The spectrum of cytological specimens studied included simple sputum smear (SS), bronchial washings (BW), post-bronchoscopy sputum (PS), brushing smears (BS)and transthoracic needle aspiration (FNA).The results of cytological examinations of all types of samples were compared to final histologic diagnosis and the diagnostic yield of each type of cytological sample was derived.
RESULTS: The distribution of histologic types in the patients studied was as follows:Small Cell Lung Cancer (SCLC) 28pts.(38%), Squamous Cell Lung Cancer (SQC) 26pts.(35%), Adenocarcinoma 13pts.(19%), Undifferentiated Carcinoma (UC) 4pts.(5%), Large Cell Carcinoma (LC) 2pts.(3%.Analysis of data showed that SS was diagnostic 24.3% of patients (relative diagnostic contribution 66.6% and 34.4% for SCLC and NSCLC respectively).BW had a diagnostic yield of 42% (almost equally partitined between SCLC & NSCLC - 52% & 48% respectively). BS diagnosed 23% 0f lung cancer of which 56.3% was the yield for adenocarcinoma. PS had a success rate of 32% of patients (equally partitined between SCLC & NSCLC.The contribution of FNA cannot be evaluated due to the small sample size (only 2 patients being successful in both). The overall contribution of cytology in the diagnosis of all studied cases with lung cancer was 57pts. among a total of 74 (77%).
CONCLUSIONS: Simple sputum cytology remains an important means of non-invasive diagnosis of lung cancer.Also,cases with adenocarcinoma bear a signifigant diagnostic success rate with brushing cytology (diagnostic success rate in more than half of cases of adenocarcinoma)
CLINICAL IMPLICATIONS: Routine use of the whole spectrum of cytological types of samples in suspected lung cancer cases, is definitely a means of non- or less- invasive and less expensive methods for elucidating the histological identity of lung cancer
DISCLOSURE: The following authors have nothing to disclose: Stylianos Michaelides, George Goulas, Eftychia Kourtelessi, Olga Vartzioti, Agathi Lekkakou, Aphrodite Emmanouelidou
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