Source: Annual Congress 2002 - Thoracic oncology: clinical management
Disease area: Thoracic oncology

Abstract

To establish a cytologic or histologic diagnosis in suspected lung cancer, flexible bronchoscopy is generally performed. Washings, brushings and forceps biopsies are often combined to increase the diagnostic yield. To our knowledge, comparison of the diagnostic yield of washing before or after biopsy and brushing have never been subject to prospective study.
A prospective study in 113 patients who underwent flexible bronchoscopy has been performed to assess the differences in diagnostic yield of washings before (I) and after (II) biopsies and brushings. All patients with a definitive histologic diagnosis of pulmonary malignancy were included. There were 70 males and 43 females; ages ranged from 39-83 years.
The diagnostic results are presented in the table.

Number of patients	Washing I	Biopsy	Brushing	Washing II	total diagnostic yield
bronchoscopically visible tumors (75)	55 (73%)	60/74 (81%)	55 (73%)	51 (68%)	71/75 (95%)
peripheral non-visible tumors(38)	16 (42%)	13/26 (50%)	19/37 (51%)	17 (45%)	24/38 (63%)
total (113)	71 (63%)	73 (73%)	74 (66%)	68 (60%)	95/113 (84%)

Comparison of washing I and II revealed that 92 cases were concordant; in 12 cases washing I was positive whereas washing II was negative and in 9 cases washing II was positive whereas washing I was negative.
In conclusion, no superiority in the diagnostic yield could be demonstrated for washings before or after biopsies and brushings. In contrast, both washings had an independant additional diagnostic value in 19% (21/113) of the cases.

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Citations should be made in the following way:
M. A. van der Drift, E. B. J. M. Thunnissen, J. P. Janssen (Nijmegen, The Netherlands). Comparison of diagnostic yield of endobronchial washing before and after forceps biopsy and brushing in bronchoscopy for pulmonary malignant tumors. Eur Respir J 2002; 20: Suppl. 38, 1179

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