The value of cytology in the diagnostics of lung cancer

In order to elucidate the relative contributions made by cytology and histology in the diagnosis of lung cancer, we studied the cytology and histology reports of all patients who received a microscopic diagnosis of lung cancer in our hospital during the 7 years 1996-2002. This gave a total of 407 patients. The most frequent diagnoses were squamous cell carcinoma (34.9%), adenocarcinoma (24.8%), and small cell carcinoma (17.8%). One hundred and fifteen patients (28.3%) received their microscopic diagnosis based only on cytology, which therefore proved to be of great diagnostic value. The most useful type of cytology specimen was taken by bronchial lavage or bronchial brushing. These types of specimens provided the diagnosis in 71 patients (17.4%). Cytology was especially capable of finding squamous cell carcinomas. Small cell carcinomas were underrepresented (9.6% versus 17.8%) and unspecified carcinomas greatly overrepresented (9.6% versus 2.9%) among the diagnoses obtained by cytology alone. We conclude that cytology is of considerable diagnostic value, although not as specific as histology for the subtyping of carcinomas. Clinicians should be more aware of the usefulness of cytology, especially in cases where it is difficult to obtain bronchoscopic biopsy samples for histological examination.     

Diagnostic accuracy of cytology and biopsy in primary bronchial carcinoma.

The accuracy of diagnosis in 656 patients with the four common histopathological types of primary lung cancer has been assessed by comparing the cell type diagnosis made on cytological and histological investigation with that determined by examination of the surgically resected or necroscopy specimen. The accuracy of diagnosis achieved by cytological examination of sputum and bronchial aspirate, and by bronchial biopsy histology was over 85%. The least accurate diagnostic procedure was percutaneous needle biopsy (62%). Squamous and small cell tumours were accurately diagnosed by all four investigations but errors were made in the diagnosis of large cell and adenocarcinomas. Nearly half the number of patients (43%) with large cell carcinoma were later reclassified as having squamous carcinoma and of the patients with adenocarcinoma 32% had been predicted to be squamous and 18% large cell carcinoma. We consider such quality control of pretreatment diagnosis mandatory in management of individual patients and before enrollment in clinical trials.     

Rinse fluid and imprint smear cytology of bronchial biopsies in diagnosis of lung tumors

The usefulness of rinse fluid and imprint smear cytology of the bronchial biopsy has been studied in diagnosis of lung cancer. However, scarce data is available regarding rinse fluid cytology of biopsy. The aim of this study was to evaluate these cytologic techniques for their diagnostic accuracy. Bronchial biopsy was taken in 52 patients clinically/radiologically suspected to have lung carcinoma. Imprint smears of the biopsy were prepared, following which it was put in balanced saline solution to collect rinse fluid of biopsy before transferring it to formalin for fixation. Cytological diagnosis from imprint and rinse fluid smears was compared with histopathological diagnosis. Malignancy was detected in 45 cases of 52 patients on histopathology. Positive result was given by rinse fluid cytology in 34 (65.4%) cases while diagnostic accuracy was 78.8%. The imprint smears were positive for malignancy in 44 (84.6%) cases with diagnostic accuracy of 98.08%. There were no false-positive results, but one case was incorrectly typed by both the techniques. Imprint smear cytology has a better diagnostic accuracy and efficacy over rinse fluid while the two cytologic techniques can be used in combination routinely with biopsy to provide an early and reliable diagnosis in lung cancer.     

Histological typing of lung cancer. Application of the World Health Organization classification to 479 cases.

Four hundred and seventy nine primary lung cancers were typed according to the WHO histological classification. The character of the material and the methods of investigation are described. All patients had been subjected to mediastinoscopy and 313 patients had been operated upon. Nearly half of the tumours (48 per cent) was epidermoid carcinomas. Small cell anaplastic carcinoma occurred in 25 per cent and around two thirds of these were of oat cell type. Adenocarcinoma was found in 22 per cent and the acinar type predominated. Bronchiolo-alveolar carcinoma occurred in 1 per cent and large cell carcinoma in 3 per cent. Typing of biopsy specimens was made in 289 cases in which a positive biopsy had been obtained during the pretreatment period. The result of the biopsy typing was checked against that of the final one. In the total group the preoperative histological diagnosis tallied with the final one in 88 per cent. In patients who had been subjected to surgery the pretreatment diagnosis of the epidermoid carcinoma was correct in 86 per cent, that of small cell anaplastic carcinoma in 92 per cent and that of adenocarcinoma in 100 per cent. The consistency was also high in the category of patients not subjected to surgery. Despite their critical attitude towards the delimitation of epidermoid carcinoma in the WHO-classification the present authors find it to be a reliable guide to routine typing of lung cancer.     

Cytological typing of primary lung cancer: study of 100 cases with autopsy confirmation.

In order to assess the accuracy of bronchial aspiration cytology in typing lung cancer, tissue sections from 100 autopsy cases of lung cancer were compared with the cytology features observed in the same patients prior to death. There was 100% accuracy in the cytology of small-cell carcinoma; 90% in squamous-cell carcinoma; 70% in adenocarcinoma; and 50% in undifferentiated large-cell carcinoma. The observed discrepancies probably reflect intrinsic tumor properties rather than problems attributable to either the bronchial aspiration method or cytology interpretation, especially in cases involving advanced lung carcinoma. Because the highest accuracy rate was in detecting small-cell carcinoma, it is recommended that only the distinction between small-cell and non-small-cell forms be made on cytologic grounds and that further categorizations only be rendered in cases with unquestionable cytomorphological features.     

The contribution of immunohistochemical staining in tumour diagnosis

With the increasing use of immunohistochemical stains in the diagnostic laboratory, it becomes relevant to review the contributions of this new technology in the area of tumour diagnosis. During 1986, our laboratory received 21,479 biopsy specimens of which 2013 were tumours. Nine hundred and fifty-eight tumours (47.5%) were subjected to immunohistochemical analysis. The biopsy and immunohistochemistry reports of 200 consecutive tumours, including 41 consultation cases, were retrospectively reviewed and assigned to one of the five categories. Immunohistochemical stains confirmed the preferred H & E diagnosis in 106 cases (53%); made the definitive diagnosis from a list of differential diagnosis in 29 cases (14.5%); provided contributory information in 36 cases (18%); were non-contributory in 27 cases (13.5%); and rendered an unsuspected diagnosis in two cases (1%). Immunohistochemical stains were particularly useful in distinguishing between malignant lymphoma and anaplastic carcinoma and in the identification of amelanotic melanoma. The application of a panel of antibodies chosen in accordance with the differential diagnoses considered was very useful in the typing of anaplastic round cell and spindle cell tumours. In 27 cases (13.5%), immunohistochemical stains were non-contributory. About half of these were referred cases and the failure to demonstrate the relevant antigens in normal tissues which served as in-built controls suggested that part of the problem may be due to differences in methods of fixation which led to sub-optimal preservation of tissue antigens. We conclude that immunohistochemical stains provide important and sometimes essential information for definitive typing of anaplastic tumours. Often the information derived was of therapeutic and prognostic relevance. We argue that this is a cost-effective test although we would caution that in all circumstances the interpretation of immunostaining must be made in the context of the histological as well as the clinical and laboratory data.     

Transbronchial needle aspiration biopsy in the diagnosis of peripheral lung lesions

In 1996-2000 in 55 patients (16 females, 39 males) admitted to Department of Phtisiopneumonology in Zabrze because of peripheral lung lesions (diameter 2.5-9.5 cm mean 4.5 cm). The transbronchial aspiration needle biopsy (TANB) was performed as diagnostic procedure during fiberoptic bronchoscopy. Subjects classified to TANB showed no pathologic changes in the bronchial tree during fiberoptic bronchoscopy. In all subjects the TANB was performed using special Wang's needles and always under fluoroscopy supervision. Based on pathologic examination of specimens obtained by Wang's needle the diagnosis was established in 29 (52.7%) cases. The most frequent diagnosis was non small cell carcinoma--in 22 (40%) of examined patients. The small cell carcinoma was confirmed only in 1 patient. In 3 (5.5%) patients tuberculosis was diagnosed. TANB was good tolerated by almost all patients, only in 1 patient small pneumothorax was recorded and in 6 cases small bleeding occurred. We conclude that transbronchial aspiration needle biopsy is safe and efficient method in diagnosis of peripheral lung tumors.     

Endoscopic brushing cytology of esophageal lesions]

Endoscopic esophageal biopsy and brushing cytology were performed simultaneously in 121 cases, 25 of which were diagnosed as esophageal cancer by histologic examination of surgically resected material or at autopsy. Correct diagnosis was made in 88% of the cancer cases by endoscopic biopsy, and the same diagnostic rate was obtained by brushing cytology. Combination of the two methods revealed the cancer in 96% of the cases. There were no cases diagnosed as false-positive or false-negative by cytology. Three cancer cases were diagnosed as suspicious by cytology. Definite diagnosis was not made because of paucity of cells on the slide or of cellular atypism. For the improvement of accuracy in cytologic diagnosis it is important to sample adequate amount of cells, and in situ carcinoma cells should be differentiated from benign atypical cells in esophagitis.     

FNA cytodiagnosis of non-Hodgkin's lymphoma and its subtyping under working formulation of 175 cases

One hundred thirty-two cases diagnosed as non-Hodgkin's lymphoma (NHL) by fine-needle aspiration cytology (FNAC) and histology, and 43 cases in which there were minor or major discrepancies between cytology and histology for diagnosis of NHL, were reviewed. The diagnostic accuracy of FNAC for NHL was 86.3% at the initial diagnosis. Following review, all the 132 cases initially diagnosed as NHL by cytology and histology remained so with minor changes in subtypes in a few cases. Of the 43 discrepant cases, 28 turned out to be NHL and 6 as Hodgkin's disease (HD); 3 were anaplastic carcinoma; and in 6 cases the discrepancy still persisted. Diagnostic accuracy of FNA for NHL improved to 98.0% following review. Categorization of histologically diagnosed NHL cases under working formulation showed that 10.4%, 21.5%, and 57.7%, respectively, were low, intermediate, and high-grade lymphomas. The corresponding figures were 16.6%, 18.4%, and 60.1%, respectively, in cytology. The diagnostic accuracy of cytology for subtyping was found to be 67.5%.     

Mediastinoscopy in bronchogenic carcinoma

Mediastinoscopy was performed in 470 patients with bronchogenic carcinoma in the ENT Department, Aalborg. The histological diagnoses were 195 squamous cell carcinomas, 149 adenocarcinomas, and 126 anaplastic carcinomas. Metastases in the mediastinal lymph nodes were found in 177 of the 470 patients (38%). Metastatic lymph nodes were found in approximately one fifth of the squamous cell carcinomas, in almost half of the adenocarcinomas, and in about half of the anaplastic carcinomas. The need is emphasized for lymph node biopsy from both right and left tracheobronchial angles and inferior to the bifurcation irrespective of the site of the carcinoma. Contralateral metastasis was found in approximately one third of the cases, and a positive biopsy from the nodes inferior to the bifurcation was found in about 40% of the patients in whom metastasis in the mediastinum were detected. In 10% of the patients, cytological and histological examinations of specimens obtained by bronchoscopy were negative, and the diagnosis of lung cancer was made by mediastinoscopy exclusively. The value of mediastinoscopy was particularly high in the diagnosis of adenocarcinomas.     

经皮肺穿刺与支气管镜活检对周围性肺癌的诊断价值

目的 对比经皮肺穿刺与支气管镜活检对周围性肺癌的诊断价值。方法 选取2014年6月~2018年7月我院就诊的69例可疑周围肺癌患者,将其随机分为两组,其中皮肺穿刺组30例,支气管镜活检组39例。比较两组患者阳性诊断率、病理诊断符合率、敏感度、特异度及并发症发生情况。结果 支气管镜活检组患者病理阳性诊断率79.48%高于皮肺穿刺组63.33%,差异有统计学意义（P＜0.05）。支气管镜活检组患者病理诊断符合率、灵敏度、特异度分别为92.31%、91.18%、100%高于皮肺穿刺的72.41%、80.95%、66.67%,差异有统计学意义（P＜0.05）。支气管镜活检组患者术后穿刺部位出血5例,气胸1例,咳血3例;皮肺穿刺组术后穿刺部位出血7例,咳血4例,气胸8例,两组间相比,差异有统计学意义（P＜0.05）。结论 在诊断周围性肺癌支气管镜活检比皮肺穿刺诊断效果更好、并发症发生率低,在临床应用时可优先考虑。     

Diagnostic accuracy of fine-needle aspiration cytology in persistent or recurrent gynecologic malignancies.

A retrospective 7 1/4-yr study was performed to evaluate the diagnostic accuracy of fine-needle aspiration (FNA) cytology in the cell typing of persistent or recurrent gynecologic malignancies. A total of 202 aspirates were obtained from 163 patients with documented malignancies of the cervix, uterus, ovary, vulva, and vagina. Information concerning the primary tumor was obtained from surgical reports and/or medical records. In 168/202 cases (83%), the histological diagnosis, including primary tumor cell type and subtype (ex. squamous cell carcinoma, large cell keratinizing), were available. In 12/202 cases (6%), only the tumor cell type (ex. squamous cell carcinoma) was known, and in the remaining 22 cases (11%), only the location of the primary neoplasm was attainable. Aspirated sites included pelvic wall and organs (77 cases), lymph nodes (51 cases), thoracic organs (18 cases), and abdominal wall and organs (56 cases), including liver (33 cases). Of the 168 cases with known histologic diagnoses, the FNA results were positive in 109 (65%). The positive results were divided into three groups: group I, the cytologic findings were predictive of the histologic diagnoses (84 cases, 77%); group II, tumor cell subtyping was not possible on cytology (17 cases, 16%); group III, neither tumor cell typing nor subtyping was possible on cytology (8 cases, 7%). Of the 34 cases in which only the histologic tumor cell type or primary tumor location was known, 13 (38%) were positive on FNA.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intraoperative squash cytology of central nervous system lesions: a single center study of 326 cases

Cytology has been shown to be of great value in intraoperative consultations of central nervous system (CNS) pathology. Intraoperative smear cytology provides a rapid and reliable intraoperative diagnosis and guidance to the neurosurgeon during surgical resection and lesion targeting. It also helps the surgeon to monitor and modify the approach at surgery. The current study was undertaken to assess the accuracy and utility of intraoperative consultations for cytomorphological diagnosis by smear technique and correlate with histopathological diagnosis. A retrospective study of 326 cases of CNS intraoperative consultations was performed. Smears were prepared from the biopsy samples sent in isotonic saline for immediate processing and stained by the Haematoxylin and Eosin method. The cytomorphological features were noted and correlated with final histopathological diagnosis. Concordance between the intraoperative diagnosis and the final diagnosis was seen in 83.7% of cases. We demonstrated >95% accuracy for glioblastomas and >89% accuracy for meningiomas and schwannomas. A reduction of diagnostic accuracy was seen in oligodendrogliomas (60%) and anaplastic oligodendrogliomas (57.2%). Smear technique is a fairly accurate, relatively safe, rapid, simple, easily reproducible, and cost effective tool to diagnose brain tumors. Smear cytology is of great value in intraoperative consultation of CNS pathology.     

Giant cell tumor of bone. A cytologic study of 24 cases

Twenty-three patients with radiologic diagnoses of giant cell tumor of bone underwent fine needle aspiration cytology and needle biopsy for tissue diagnosis before curettage or resection. One patient had two tumors, making a total of 24 cases. The accuracy of the cytologic diagnosis was compared with that of tissue biopsy. Cytologically there were mononucleated and multinucleated cells. The former often occurred in clusters or, less often, were dispersed. They had spindle or plump cell bodies with moderate amounts of cytoplasm and well-defined cytoplasmic membranes. The oval nuclei demonstrated fine, evenly distributed chromatin and small nucleoli. The multinucleated cells were osteoclastlike and were associated with the clusters of mononucleated cells or lying freely. They had a well-demarcated cytoplasm and contained from a few to several dozen monomorphic nuclei. Cytologic diagnosis was made in 20 of 24 cases, and histologic diagnosis was made in 21 of 24. Insufficient diagnostic material for cytology was the reason for failure in 4 cases. This was attributed to faulty technique (2 cases), cystic change (1 case), and massive necrosis (1 case). As other benign and malignant bone tumors may contain benign giant cells, cytologic or histologic findings alone are not diagnostic of giant cell tumor of bone, but should be complemented with the clinicoradiologic findings. Aspiration cytology is as accurate as tissue needle biopsy, may be of high diagnostic value in deeply located lesions not amenable to cutting needle biopsy, and should be done with full knowledge of the clinicoradiographic information.     

Accuracy of bronchial aspiration cytology in typing operable (stage I-II) pulmonary carcinomas.

The accuracy of bronchial aspiration cytology in typing resectable (stage I-II) lung cancer has been investigated in 100 cases, comparing preoperative cytologic features with pulmonary tumor histology seen at surgery. The accuracy has been 100% for small-cell carcinoma (two cases), 98.8% for squamous-cell carcinoma (86 cases), and 91.6% for adenocarcinoma (12 cases). The overall accuracy rate has been 98%. No case of undifferentiated large-cell carcinoma has been identified. It is suggested that the high accuracy in cytologic typing of operable lung cancer is basically related to adequate preservation of differentiation features, thus allowing for correct identification of most non-small-cell carcinoma. Moreover, the absence in this study of any large-cell carcinoma, compared with its frequency in advanced stage series, would indicate that such a histotype reflects excessive dedifferentiation of an original squamous or glandular form.     

肺细针吸取微小组织学与细胞学检查诊断价值的探讨

目的探讨经皮细针肺肿块吸取细胞块和微小碎片组织学(简称微小切片)与涂片细胞学的诊断价值.方法对有组织学对比的187例经皮细针(7号) 肺部肿块吸取资料作微小切片组织学与涂片细胞学比较分析.结果 (1)微小切片组的诊断敏感性88.3%,特异性100%,总准确率89.5%;涂片组分别为87.7%、93.8%和88.8%;涂片结合微小切片则分别为91.6%、93.8%和92.0%.(2)微小切片组对恶性肿瘤的组织分型准确率93.3%(83/89),比涂片组的67.9%(91/134)高(P<0.01).对良性病变分类诊断准确率分别为86.4%(19/22)和 60.0%(18/30) (P<0.05).(3)66.3%的病例获取微小组织切片,其免疫组织化学染色结果与术后病理组织切片的相同.结论微小切片组织学和细胞学的诊断准确性均高,两者结合应用将提高诊断准确性,前者对组织分型、分类诊断接近术后病理诊断,有很高的应用价值.     

Cytologic diagnosis of lung cancer. Principles and problems

This diagnostic seminar discusses the current status of the principles and problems of cytology as it is applied to the diagnosis of lung cancer. This discussion is divided into four major parts. Part I presents a discussion of cytopreparatory techniques and cytology of the lung in the absence of cancer. The cytology of benign proliferations which may mimic cancer is emphasized. The role of cytology in the diagnosis of pulmonary infectious organisms is noted. Part II discusses lung cancer as manifested in specimens of sputum, bronchial washings, and bronchial brushings. Part III presents some data on the validity of cytology with respect to role of specimen number and type in lung cancer diagnosis and cell typing in lung cancer. The continued usefulness and importance of multiple specimens of sputum for lung cancer diagnosis are documented. Part IV presents a brief synopsis of fine needle aspiration biopsy of lung cancer.     

Diagnosis of lung disease in acquired immune deficiency syndrome: biopsy or cytology and implications for management.

One hundred and twenty consecutive bronchoscopic examinations were carried out on 80 patients with acquired immune deficiency syndrome (AIDS) between January 1982 and December 1986. Ninety one paired biopsy and cytology specimens from 72 of these patients were analysed. There was no significant difference between biopsy and cytology in diagnosing Pneumocystis carinii pneumonia (0.95 greater than p greater than 0.1). In 10 cases P carinii pneumonia was diagnosed by biopsy but not cytology and in seven cases by cytology but not biopsy. Nineteen patients had multiple infections or Kaposi's sarcoma. Biopsy was more useful than cytology in the diagnosis of other infections (n = 20) and Kaposi's sarcoma (n = 2) with positive cytological correlation in only three of the infections. Biopsy and cytology together have a diagnostic yield of 78.3%. We conclude that all patients presenting with respiratory disease who have, or are in a high risk group for, AIDS should be examined by bronchoscopy at an early stage with both cytology and biopsy.     

Primary lymphoma of the breast: a clinicopathological study

3 cases of primary non Hodgkins lymphoma of the breast are described, seen over a period of 2 years among 199 cases of breast malignancies. All were diffuse large B cell type. Application of immunohistochemistry greatly aids in differentiating lymphoma from anaplastic carcinoma, with which it can easily be confused. Preoperative diagnosis on a trucut biopsy is an ideal diagnostic method since diagnosis on fine needle aspiration cytology or frozen section may not be possible. Primary breast lymphoma is a rare disease with reported incidence of 0.04-0.53% of all breast malignancies in most series. Accurate diagnosis is essential, so that appropriate treatment may be applied. Two cases were treated with CHOP chemotherapy and radiotherapy along with surgical excision. One case was treated with CHOP chemotherapy.     

Comparison of fine needle aspiration cytology and needle core biopsy in the diagnosis of radiologically detected abdominal lesions

AIMS: To compare the sensitivity and specificity of percutaneous fine needle aspiration (FNA) cytology and needle core biopsy (NCB) in the diagnosis of suspected intra-abdominal tumours. METHODS: One hundred and forty one consecutive patients who underwent radiologically guided combined FNA/NCB of abdominal lesions over a four year period were reviewed. The diagnostic accuracy of both techniques and the value of rapid staining and assessment of cytological preparations were assessed. RESULTS: FNA cytology and NCB identified 111 of 129 (86%) and 104 of 129 (80.6%) malignant lesions, respectively; in combination, the sensitivity increased to 90.7%. The diagnostic specificity was 100% for both methods, although one case of phaeochromocytoma was misinterpreted as undifferentiated carcinoma on biopsy. More accurate tumour subtying was possible in two cases with FNA and four cases on NCB. The series included 12 benign lesions, of which 11 and nine were accurately identified on FNA and NCB, respectively. Two specific benign diagnoses (Budd-Chiari syndrome and hepatic infarct) were made only on biopsy. The use of rapid assessment cytology preparations ensured that appropriate samples were submitted for microbiology in three liver abscesses, and provided an accurate cytological diagnosis at the time of the procedure in 103 of 141 (73%) cases. None of the patients suffered biopsy related complications. CONCLUSIONS: FNA cytology is more sensitive and accurate than NCB in the diagnosis of abdominal lesions, and also offers more rapid diagnosis. However, the combination of these sampling techniques increases diagnostic sensitivity and occasionally provides more accurate classification of tumours and benign lesions. The techniques should be considered complementary in the investigation of abdominal lesions.