Comparison between bronchial washings, bronchial brushings and blind transbronchial needle aspiration in suspected bronchogenic carcinoma patients without intraluminal growth on bronchoscopy

摘要

Bronchogenic carcinoma with spread along the mucosal plane presents as an exophytic mass, which is documented to have high success rate of diagnosis by standard diagnostic procedures (bronchial washing, brushing and forceps biopsy). However, the predominantly submucosal and peribronchial patterns of the disease are harder to detect by these techniques. We sought to investigate the utility of transbronchial needle aspiration in the diagnosis of bronchogenic carcinoma without intraluminal mass, through prospective analysis of routine diagnostic broncho-scopies performed in a 24-month period, at a tertiary care hospital in south India. Of the 42 patients assessed, 29 had malignancy confirmed by forceps biopsy or Computed Tomography (CT) guided Fine Needle Aspiration Cytology (FNAC) or Biopsy (FNAB) and bronchoscopy. Among them, 17 cases were detected by a combination of the results of bronchial washing, brushing and transbronchial needle aspiration. The individual sensitivities (n = no. of cases detected) amounted to 3.4% (n=I). 51.72% (n=15) and 27.6% (n=8) respectively. There were no false positive results. Concerning different bronchoscopic sampling techniques. 9 cases were diagnosed solely by bronchial brusliings and 2 cases by transbronchial needle aspiration alone. No periprocedural complications were encountered. We conclude that the value of bronchial brushing in the diagnosis of bronchogenic carcinoma without bronchoscopically visible intraluminal mass is above that of blind transbronchial needle aspiration. Addition of bronchial washings, to bronchial brushings and transbronchial needle aspirate has an insignificant impact on the diagnosis. Yet. owing to its cost-effectiveness and simplicity, it is recommended to be performed routinely for diagnosing these patients.