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      Comparative study of bronchoalveolar lavage, bronchial brushing, and FNAC in diagnosing malignant neoplasms of lungs

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          Abstract

          Background:

          Lung cancer is the leading cause of death in developed countries and is increasing at alarming rates in developing countries. Cytological techniques such as bronchoalveolar lavage (BAL), bronchial brushing (BB), and fine needle aspiration cytology (FNAC) can aid in the early diagnosis of lung malignancies.

          Materials and Methods:

          A total of 67 cases, suspected of lung cancer between January 2010 and December 2012, were selected where samples of BAL, BB, FNAC, as well as biopsy were obtained and processed according to the standard procedures of cytology and histology. The aim of this study was to compare the diagnostic efficacy of the three modalities, i.e., BAL, BB, and FNAC in diagnosing malignant neoplasms of the lung. Biopsy was considered to be the gold standard diagnostic test.

          Results:

          Sensitivity of BAL, BB, and FNAC was found to be 47.61, 65.07, and 88.88%, respectively, whereas specificity of BAL, BB, and FNAC was 75, 75, and 100%, respectively.

          Conclusions:

          FNAC is the best technique among the three for the diagnosis of lung cancers.

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          Most cited references19

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          Complications of fiberoptic bronchoscopy at a university hospital.

          C A Pue, E Pacht (1995)
          To retrospectively review the indications and complications associated with flexible fiberoptic bronchoscopy (FFB) in a university teaching hospital. retrospective review from April 1, 1988 to March 30, 1993. Large tertiary care university hospital. We reviewed 4,273 consecutive FFBs, including 2,493 bronchoalveolar lavages and 173 transbronchial biopsy procedures. None. Most (52%) FFBs were performed for obtaining lower respiratory tract samples for evaluation of suspected infection. An additional 17% were performed to evaluate an abnormality seen on chest radiograph. The most common therapeutic indication was removal of retained secretions in 8% of FFBs. The mortality rate was 0%, and the frequency of major and minor complications was 0.5% and 0.8%, respectively. The incidence of major complications secondary to transbronchial biopsy was 6.8%. Flexible fiberoptic bronchoscopy can be performed safely in a teaching hospital with appropriate preparation, supervision, and adherence to protocol.
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            Lung cancer in India.

            D. Behera, T. Balamugesh (2015)
            Lung cancer is one of the commonest malignant neoplasms all over the world. It accounts for more cancer deaths than any other cancer. It is increasingly being recognized in India. We did a systematic review of the published studies on epidemiology, diagnosis and treatment of lung cancer in India. Literature from other countries was also reviewed. With increasing prevalence of smoking, lung cancer has reached epidemic proportions in India. It has surpassed the earlier commonest form of cancer, that of oropharynx, and now is the commonest malignancy in males in many hospitals. In addition to smoking, occupational exposure to carcinogens, indoor air pollution and dietary factors have recently been implicated in the causation of lung cancer. Squamous cell carcinoma is still the commonest histological type in India in contrast to the Western countries, although adenocarcinoma is becoming more common. Molecular genetics of lung cancer has opened up new vistas of research in carcinogenesis. Various modalities for early detection through screening are being investigated. Majority of the patients have locally advanced or disseminated disease at presentation and are not candidates for surgery. Chemotherapy applied as an adjunct with radiation improves survival and the quality of life. New anticancer drugs, which have emerged during the last decade, have shown an improved efficacy-toxicity ratio. In view of our large population, the burden of lung cancer will be quite enormous in India. Drastic measures aimed at discouraging people from smoking must be taken to reduce the morbidity and mortality due to lung cancer.
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              Percutaneous transthoracic needle aspiration biopsy: a comprehensive review of its current role in the diagnosis and treatment of lung tumors.

              Ethan K. Scott, Matthew Thorpe, R C Larscheid (1998)
              The purpose of this study is to examine the accuracy and complications of transthoracic needle aspiration biopsy (TTNA) to determine its optimal role in the evaluation of patients with lung tumors. The charts of 130 consecutive patients who had undergone CT-guided TTNA were reviewed retrospectively. Thirty-two (25%) of these patients had subsequent surgery and 5 had subsequent transbronchial biopsy (TBB). Using the final surgical and TBB diagnosis as a reference, the accuracy, sensitivity, specificity, and prevalence of malignancy were calculated. Each case was also examined to determine the presence or absence of complications. Of the 130 biopsy results, 95 (73%) were malignant, 33 (25%) were nonspecific, and only 2 (2%) had a specific benign diagnosis. Thirty-two patients subsequently underwent surgical resection. The overall prevalence of malignancy after surgical diagnosis was 91%. The overall diagnostic accuracy of TTNA was 76%. The sensitivity of TTNA for the detection of malignancy was 74% and its specificity was 100%. When comparing TTNA results of small ( or = 3 cm) tumors, the occurrence of nonspecific results was 36% and 16%, respectively. Fifty-six (43%) patients had a pneumothorax subsequent to TTNA. Twenty-four (43%) of these patients required a chest tube and remained hospitalized for a mean of 6 days. Patients who are surgical candidates and have a high clinical suspicion for malignancy should undergo surgical biopsy and resection of their lung tumors if indicated. Information gained from TTNAs performed on this patient population will rarely result in a change in their clinical management.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Cytol
                Journal ID (iso-abbrev): J Cytol
                Journal ID (publisher-id): JCytol
                Title: Journal of Cytology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0970-9371
                ISSN (Electronic): 0974-5165
                Publication date (Print): Oct-Dec 2016
                Volume: 33
                Issue: 4
                Pages: 210-213
                Affiliations
                [1]Department of Pathology, SMS Medical College, Jaipur, Rajasthan, India
                [1 ]Department of Pathology, KEM Hospital, Pune, Maharashtra, India
                [2 ]Department of Pathology, JLN Medical College, Ajmer, Rajasthan, India
                [3 ]Department of Respiratory Medicine, JLN Medical College, Ajmer, Rajasthan, India
                Author notes
                Address for correspondence: Dr. Vijeta Tomar, 113, Ganga Vihar Colony, Mahesh Nagar, Jaipur - 302 015, Rajasthan, India. E-mail: dr.vijetatomar@ 123456gmail.com
                Article
                Publisher ID: JCytol-33-210
                DOI: 10.4103/0970-9371.190448
                PMC ID: 5156984
                SO-VID: c9643a16-47e5-4ae0-b595-fb22452db793
                Copyright © Copyright: © 2016 Journal of Cytology
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Pathology
                Keywords: bronchial brushing,bronchoalveolar lavage,diagnostic efficacy,fnac
                Data availability:
                ScienceOpen disciplines: Pathology
                Keywords: bronchial brushing, bronchoalveolar lavage, diagnostic efficacy, fnac

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