Difference in the Yields of Bronchial Washing Cytology before and after Forceps Biopsy for Lung Cancer Diagnosis
Suree Sompradeekul MD*, Usana Chinvetkitvanich MD*, Panthep Suthinon MD**, Sommit Wongbunnate MD**
Affiliation : * Division of Respiratory Disease and Tuberculosis, Department of Medicine, Siriraj Hospital ** Department of Pathology, Siriraj Hospital, Mahidol University
Objectives : Fiberoptic bronchoscopy (FOB) has been one of the essential procedures used in the diagnosis of
lung cancer. Diagnostic yields of FOB related procedures such as bronchial washing (BW), bronchial brush-
ing (BB), bronchial biopsy (BBx), and transbronchial biopsy (TBBx) depend on the location and extent of the
tumors. The yields of BW vary among different studies (39-79%). Some reported that the yield might increase
in post-bronchoscopic sputum. Since samples from BW are obtained directly from the respiratory tract, we
hypothesized that post bronchoscopic forceps biopsy BW might further increase the yield as well. The objec-
tive of this study was to compare the diagnostic yields of bronchial washing before and after forceps biopsy for
lung cancer.
Materials and Methods : 114 patients, 70 with endobronchial lesions (42 exophytic lesions, 28 submucosal
lesions) and 44 with non-endobronchial lesions, suspected to have lung cancers were evaluated at Siriraj
Hospital between March and October 2000. All the patients underwent FOB with initial BW then forceps
biopsy (BBx or TBBx) of the lesions followed by re-BW. The cytological specimens were blinded to the
cytopathologists. Positive cytologic results of each procedural specimen were compared to final malignancy
diagnosis (by positive specimens from FOB, transthoracic needle aspiration, surgery, clinical and radiologi-
cal follow-up) to determine the sensitivity of each test.
Statistical analysis: Chi-square test comparing sensitivity of each test.
Results : 82 /114 patients (39 patients had exophytic lesions, 24 patients had submucosal lesions, and 19
patients had peripheral lung lesions) had a final diagnosis of malignancy. The sensitivity of initial BW before
forceps biopsy was 37.8% (31/82), re-BW after forceps biopsy was 37.8% (31/82), both initial BW and re-BW
was 46.3% (38/82), and forceps biopsy alone was 79.3% (65/82). There was no statistically significant
difference (p>0.05) in the sensitivity of initial BW, re-BW and combined initial BW and re-BW. No major
complications such as massive hemorrhage, respiratory failure, or death occurred.
Conclusion : The diagnostic yields of BW before and after forceps biopsy for malignancy were not different in
our study. However, the yield seemed to be higher when combined pre and post-forceps biopsy BW was used.
Keywords : Bronchial washing, Cytology, Forceps biopsy, Transbronchial biopsy, Bronchoscopy, Lung can- cer, Diagnostic yields
