PURPOSE: There is an array of diagnostic tools available for detection of lung cancer. The optimal approach is one that leads to a conclusive diagnosis in shortest possible time, with minimal cost and least morbidity.
METHODS: The study covers 80 adult patients of cytological or histo-pathological proved lung carcinoma from a tertiary hospital between March 2008 and February 2009. Those with metastasis in lungs were excluded. The diagnostic tools evaluated include sputum cytology, Fibre-optic bronchoscopy (FOB) with examination of bronchial brushings, washings and biopsy specimens; Computed Tomography (CT) guided fine needle aspiration cytology (FNAC) of lung lesions and biopsy of peripheral lung lesions by Vim tru-cut needle.
RESULTS: Sputum cytology for malignant cells done in all cases was positive in 27 cases (33.75%). Yield was more in central than peripheral lesions (72.72% vs. 18.18% respectively). FOB was done in 52 patients and bronchial biopsy was positive in 40 (76.92%) whereas brushing and washing was positive in 25 (48%) and 23 (44.23%) patients respectively. CT guided FNAC of lung lesion was done in 39 patients and was positive for malignancy in 36 patients (92.3%). Seven patients with peripheral lesions were selected for tru-cut lung biopsy and malignancy was found in all of them (100%). Complications like pneumothorax was encountered in two (28.5%) cases of tru-cut lung biopsy and four (10.25%) cases of CT guided FNAC, hemoptysis was seen in three (5.76%) cases of FOB and one (2.56%) case of CT guided FNAC and bronchospasm occurred after FOB in 10 (19.23%) cases.
CONCLUSION: CT guided FNAC is a safe and highly sensitive diagnostic tool for lung cancer. The yield in FOB depends upon the site, size of lesion and the experience of bronchoscopist. Tru-cut lung biopsy is highly sensitive for peripheral lesions but is relatively unsafe.
CLINICAL IMPLICATIONS: The judicious selection of the right diagnostic tool for lung cancer should be based on the knowledge of merits, demerits, sensitivity, limitations, complications and cost effectiveness of each procedure.
DISCLOSURE: Sourin Bhuniya, No Financial Disclosure Information; No Product/Research Disclosure Information