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Diagnostic value of bronchial wash, bronchial brushing, fine needle aspiration cytology versus combined bronchial wash and bronchial brushing in the diagnosis of primary lung carcinomas at a tertiary care hospital

Different cytological techniques have been successfully applied for the diagnosis of primary lung cancers. Flexible fiberoptic bronchoscopy has served as a major breakthrough in respiratory cytology, as bronchial brushings, washings and fine needle aspiration have become more easy, accessible and cost effective.This study aims to determine the diagnostic value of bronchial wash (BW), bronchial brushing (BB) and fine needle aspiration (FNA) cytological samples in diagnosing primary lung carcinoma, among patients attending King Abdulaziz University Hospital, Jeddah Saudi Arabia. A retrospective analysis was performed to compare the diagnostic value of the three specimens’ types among patients with a clinical suspicion of primary lung carcinoma. All cytology specimens of bronchial washing, bronchial brushing and fine needle aspirate of lung performed for a clinical diagnosis of primary lung carcinoma, between Jan 2000- Dec 2013, were identified and evaluated in comparison to their respective histological correlations. Combined BB + BW showed the best sensitivity (90.6%), specificity (75%), PPV (98%) and Global Accuracy (89.5%), when compared to any of the three techniques employed individually. In ROC curves analysis, combined BB + BW showed the highest diagnostic significance with an Area Under Curve (AUC)=.828 (p value = .030), followed by BB with an AUC=.774 (p value=.004) and FNA with an AUC = .767, (p value= .042). Combination of bronchial brush and bronchial wash complement each other and enhance the diagnostic efficacy of lung cytology for the diagnosis of primary lung carcinoma and are more superior when compared with bronchial brush, bronchial wash or FNA performed individually.

Author(s): Shagufta Tahir Mufti, Ghadeer A. Mokhtar