Original Research Article
Year: 2019 | Month: November | Volume: 9 | Issue: 11 | Pages: 1-9
Bronchial Brushing Cytology in Evaluating Lung Cancer: Efficacy and Pitfalls
Prajwala Gupta1, Manjari Kishore2, Manju Kumari3, Manju Kaushal4, Minakshi Bhardwaj4, Desh Deepak5
1Associate Professor, 2Senior Resident, 3Junior Resident, 4Professor,
Department of Pathology, Post Graduate Institute of Medical Education and Research; Dr.Ram Manohar Lohia Hospital, New Delhi.
5Professor, Department of Respiratory Medicine, Post Graduate Institute of Medical Education and Research; Dr.Ram Manohar Lohia Hospital, New Delhi.
Corresponding Author: Manjari Kishore
ABSTRACT
Introduction: Lung cancer is one of the most common cause of mortality among cancer patients. A comprehensive clinicopathological approach is needed for labelling a correct diagnosis. Cytological diagnosis following fine needle aspiration (FNA) plays a pivotal role in diagnosis of lung cancer; especially in advanced stages and cases where biopsy may not be feasible. Besides, there is diagnostic role of exfoliative cytology by bronchial brushings which is a non-invasive procedure.
Aims & Objective: In the current 6-year-study, we study the role of bronchial brushing cytology in evaluation of lung cancer and its correlation with histopathology.
Materials & Methods: The present study is a retrospective study done in Department of Pathology for a period of 6 years (January 2012- December 2017). A total of 302 reported cases of bronchial brushing cytology were included. Categorisation was done based upon cytological diagnosis; however, immunocytochemistry was not done due to financial constraint. Histological correlation along with immunohistochemistry was done wherever available.
Results: Out of a total of 302 bronchial brushing cytology specimens, 208 were males and rest 94 females. The age of the patients ranged from 17-84 years with a mean age of 50.2 years. Histological findings were available in 152 cases. A total of 68 cases were reported as malignant on cytology; of which 36 cases had positive histological correlation and in rest 11 cases biopsy was inadequate. Eighty-four cases with negative cytological findings had similar histology (p value <0.05); however, 21 cases which were reported as negative on cytology had evidence of malignancy on histology. An attempt to classify the tumors into small cell lung carcinoma (SCLC) and non-small lung carcinoma (NSCLC) was done along with subclassification into adenocarcinoma and squamous cell carcinoma wherever possible. Diagnostic difficulty leading to misdiagnosis was noted in 5 cases. Few cases of pulmonary tuberculosis and occasional rare malignancies were also diagnosed on bronchial brushings while evaluating the patients clinically suspected for lung carcinoma.
Conclusion: Bronchial brushing cytology can play an excellent role in initial evaluation of lung cancer by giving an early diagnosis. Subclassification of lung tumors into SCLC or NSCLC can rarely be difficult on cytomorphology alone. In cases where biopsy is not feasible or histological findings are inadequate, bronchial brushing cytology is a reliable alternative for an early diagnosis and patient management.
Key words: Bronchial brushing, lung carcinoma, pulmonary tuberculosis, exfoliative cytology.