ABSTRACT
Lung cancer is one of the most common malignancies worldwide with high mortality. Furthermore being one of the most insidious and aggressive neoplasm in the realm of oncology, it’s timely diagnosis and accurate subclassification becomes pre-requisite for administering appropriate and timely target therapy. In the present study, cell block from brush tip washings were prepared and immunoreactivity assessed for cytokeratin5/6, TTF-1 and CD56 with aim to diagnose and sub-classify carcinoma lung. Methods: The present study was conducted on 25 specimens of brushtip washings from suspected cases of carcinoma lung. Bronchoscopic investigation of pulmonary lesions was performed and routine brush smears were made and these brush tip were processed into cell block. Immunohistochemical staining for marker CK5/6, CD56 & TTF 1 was done and evaluated. Results: Brush smear cytology finding was mostly benign seen in 12 (48%) followed by SCC seen in 4 (16%), ADC in 3 (12%). Cell block microscopy showed SCC in 11 (44%), ADC in 5 (20%), small cell carcinoma in 3 (12%) and carcinoma in 3 (12%). It was inadequate in 3 (12%). The difference was significant (P< 0.05). Sensitivity and specificity of brush smear cytology in diagnosing lesion was 33.3 % and 52.6% respectively.Whereas for cell block microscopy in diagnosing lesion sensitivity was 91.67% and specificity 86.6%. The overall sensitivity of IHC CK 5/6 in diagnosing SCC was 100% and specificity was 52.4%. CD56, TTF1 were negative in these cases. CD56 showed 100% sensitivity in diagnosing small cell carcinoma with specificity being 24.6%, The overall sensitivity of IHC TTF 1 in diagnosing ADC was 100% & for small cell carcinoma was 40%. Conclusion: Cell block preparation is a simple method that increases diagnostic yield of flexible bronchoscopy, is cost effective & hence can be routinely used. IHC panel consisting CK 5/6, CD 56 and TTF 1 has more diagnostic value in precise subtyping of different types of lung carcinoma in adjunction to routine H&E staining.
ABSTRACT
Diagnosis of pleural diseases creates difficulty due to overlapping features of various benign and malignant conditions. However pleural fluid cytology of closed pleural biopsy specimen is most commonly used procedure to diagnose various pleural diseases in developing country like India. Present study was conducted to establish diagnostic utility of ADA in Pleural Fluids and its correlation with cytological findings. Methods: The present study includes 100 samples of pleural fluid samples taken from patients coming to the Department of Chest and TB, Government Medical College and Hospital, Amritsar with the complaint of pleural effusion. Results: For ADA levels in pleural fluid Sensitivity is 92%, Specificity is 81.33%, Positive predictive value is 62.16% and Negative predictive value is 96.83%. For lymphocyte count in pleural fluid Sensitivity is 100%, Specificity is 16.67%, Positive predictive value is 31.25 % and Negative predictive value is 100%. In Combination of ADA and lymphocyte count to diagnose tubercular pleural effusion Sensitivity is 100%, Specificity is 77.27%, Positive predictive value is 82.14 % and Negative predictive value is 100%. Conclusion: Measurement of ADA level in pleural fluid in combination with the differential count of pleural fluid will give best results to categorize and to rule in the diagnosis of tubercular pleural effusion.