ABSTRACT
Lung cancer is the most common cancer around the world and is associated with significant mortality. Smoking is the most important risk factor. Screening and early diagnosis has significant role in initiating treatment and reducing mortality rates. Also, definite histological subtyping is mandatory for newer therapeutic strategies. Over the past decades, screening for lung cancer has evolved with the advent of bronchoscopy and cytological evaluation. Even though various biomarkers of lung cancer are in study, cytological evaluation of bronchial brushing and washing has become a useful and cost-effective screening method for lung cancer and is widely used all around the world.METHODSIt was a comparative cross-sectional study conducted in the Department of Pathology, Government Medical College, Thrissur, from 1-1-2017 to 30-6-2018. Bronchial washing and brushing specimens received along with biopsy, which are suspicious for bronchogenic carcinoma were included in the study. Sample size was 82. Cytological smears are stained with Giemsa staining and Papanicolaou’s staining. Biopsy specimens are stained with haematoxylin and eosin staining after processing.RESULTSMajority of patients were in the age group of 60 – 79 years (75.6%), and mean age was 64.14 years. Cigarette smoking was seen in 55 patients (67.1%). Out of the 82 cases, 46 cases (56%) were squamous cell carcinoma, 14 cases (17%) were adenocarcinoma, 15 cases (18.3%) were non-small cell carcinoma- NOS, 7 cases (8.6%) were small cell carcinoma. Positivity rates for malignancy with brushing was 52.4%, washing 19.5% and combined 54.9%. Bronchial brushing had a sensitivity of 19.6% in squamous cell carcinoma, 28.6% in adenocarcinoma, 26.7% in non-small cell carcinoma (NSCLC)-NOS, 28.6% in small cell carcinoma (SCLC). Compared to bronchial brushing, the sensitivity of bronchial washing was lower and combination of washing with brushing yielded no additive effects except in adenocarcinoma cases.CONCLUSIONSAmong routinely employed cytological techniques in our centre for a diagnosis of bronchogenic carcinoma, bronchial brushing has higher sensitivity and specificity than bronchial washing. Even though the combination of both cytological techniques yielded not much difference in sensitivity and specificity than brushing alone, usefulness of bronchial washing was evident in adenocarcinomas. Therefore, bronchial brushing, washing and biopsy should be done in the evaluation of suspicious bronchogenic carcinoma and major importance in the processing, evaluation and analysis of brushing will be useful in better cytological diagnosis.