Cytological and immunocytochemical study of bronchial wash in bronchogenic carcinoma

ABSTRACT

Carcinoma of the lung has became the most common type of cancer since 1985 and the most common cause of cancer death in both males and females. To assess the diagnostic accuracy of bronchial wash cytology and application of immunocytochemical methods, using two tumor markers [low molecular weight cytokeratin and epithelial membrane antigen] for more accurate and precise diagnosis of lung tumors. Fifty fifes suspected lung cancer cases according to their clinicoradiological examinations were included in this study. Bronchial wash cytology was performed for all the 55 patients. Smears were stained by conventional cytological stain inaddition to immunocytochemial staining using low molecular weight cytokeratin and epithelial membrane antigen. The final results of bronchial wash were compared to histopathological results and final clinical diagnosis as. Cytological smears of bronchial wash revealed the presence of malignant cells in 33 cases [60%]. The sensitivity of bronchial wash cytology was 82.5%; the specificity was 100.0%, with overall accuracy of 87.3%. Using cytokeratin staining, 26 cases [47%] were positive for malignant cells, and 29 were negative. The sensitivity, specificity and overall accuracy were 65%, 100%, and 74.5% respectively. With EMA staining, 19 cases [27%] were positive for malignant cells and 36 were negative. The sensitivity, specificity and overall accuracy were 47.5%, 100%, and 61.8% respectively. Combined use of CK and EMA raised the sensitivity to 72.5%, specificity of 100% and overall accuracy of 80%. Combined use of monoclonal antibodies and conventional cytology raised the sensitivity to 95%, specificity 100%, with overall accuracy of 96.3%. Using more than one monoclonal antibody, or using combined conventional cytology and immunocytochemistry increase the sensitivity for detection of malignant cells in bronchial wash smears