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JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES
A Study Of
Correlation Of Bronchial Brushing Cytology With Bronchial Biopsy In
Diagnosis Of Lung Cancer. J Pharm Biomed Sci 2014; 04(06):492-496.
Pancharia A, Yadav V, Taneja C, Chauhan S, Chauhan R, Gauttam V.,
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ISSN NO- 2230 – 7885
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NLM Title: J Pharm Biomed Sci.
Research Article
A Study Of Correlation Of Bronchial
Brushing Cytology With Bronchial Biopsy
In Diagnosis Of Lung Cancer
1,*
2
3
4
5
Aruna Pancharia , Vandana Yadav , Charu Taneja ,Sunanda Chauhan , Rupa Chauhan ,Vinod Gauttam
Affiliation:1
M.D. Scholar, Department of Pathology Geetanjali
Medical College & Hospital, Udaipur (Raj.),India
2
M.D. Scholar,Department of Pathology M. G. Institute
of
Medical
Sciences
Sewagram
Wardha
Maharashtra,India
3
Assistant Prof. Department of Anatomy Geetanjali
Medical College & Hospital, Udaipur (Raj.),India
4
Assistant Prof. Department of Pathology Geetanjali
5
Medical College & Hospital, Udaipur (Raj.),India
DCP, Department of Pathology Geetanjali Medical
College & Hospital, Udaipur (Raj.),India
6
Medical officer at Savina Khera PHC Udaipur,India
The name of the department(s) and institution(s) to
which the work should be attributed:
1.Department of Pathology, Geetanjali Medical College
& Hospital, Udaipur (Raj.),India
2 Department of Pathology M. G. Institute of Medical
Sciences Sewagram Wardha Maharashtra,India
3 Department of Anatomy Geetanjali Medical College
& Hospital, Udaipur (Raj.), India
4 Medical College & Hospital, Udaipur (Raj.),India
Authors contributions
All of the authors drafted, revised the article and
approved the final version.
*To whom it corresponds:-
Dr. Aruna Pancharia.
Department of Pathology Geetanjali Medical College &
Hospital, Udaipur (Raj.), India
E mail Address: [email protected]
Abstract
Introduction: Lung cancer is one of the commonest
malignant neoplasm all over the world. lt accounts
for more cancer deaths in both men and women
worldwide than any other cancer and is increasingly
1
being recognised in India . Lung cancer is one of the
leading causes of death in western countries and In
India also, lung cancer is most common in males in all
urban registries. Fiberoptic bronchoscopy has an
492
6
excellent result in diagnosis of lung cancer when
combined with brushing cytology & biopsy2.
Method: A total of 58 cancer positive biopsies were
included in this study on whom bronchoscopy was
performed specimens were collected over the period
of 2 year. Bronchial brushing, biopsy specimens were
collected & processed accordingly.
Results: Out of 58 malignant cases, the most
common was the squamous cell carcinoma (58.62%),
followed by adenocarcinoma (18.96%), small cell
carcinoma (12.06%), miscellaneous (8.62%) & large
cell carcinoma (1.72%). There were 53 male & 5
female with male to female ratio 10.6. The average
age of the cases ranged from 21 years to 86 years,
the average age being 59 years. Thus, cytohistological
correlation was done in 58 malignant cases.
Conclusion: Bronchial biopsy has better detection
rate than brushing cytology in this study. Bronchial
brushing cytology is an inexpensive, less invasive,
quick and effective diagnostic tool in detection of
lung cancer. However combination of these
modalities gives higher detection rate for
bronchoscopically visible tumor. Therefore, bronchial
brush cytology should be performed whenever
possible in all suspected cases of lung cancer.
Keywords: Bronchial brushing cytology; bronchial
biopsy, lung cancer.
Source of support: None
Competing interest / Conflict of interest
The author(s) have no competing interests for financial
support, publication of this research, patents and
royalties through this collaborative research. All
authors were equally involved in discussed research
work. There is no financial conflict with the subject
matter discussed in the manuscript.
ISSN NO- 2230 – 7885
CODEN JPBSCT
NLM Title: J Pharm Biomed Sci.
Article citation:
Pancharia A, Yadav V, Taneja C, Chauhan S, Chauhan R, Gauttam V. A study of correlation of bronchial brushing cytology
with bronchial biopsy in diagnosis of lung cancer . J Pharm Biomed Sci 2014;04(06):492-496. Available at
www.jpbms.info.
INTRODUCTION
C
ytological method in diagnosis of cancer of
respiratory tract has been acclaimed as one
of best application. With the use of flexible
fiber optic bronchoscope, respiratory cytology
become efficient enough in taking sample of
bronchial washing, bronchial brushing, bronchoalveolar lavage and transbronchial needle
aspiration, and yielding significant amount of
material3. Lung cancer is one of the commonest
malignant neoplasm all over the world. lt accounts
for more cancer deaths in both men and women
worldwide than any other cancer and is
increasingly being recognized in India. Lung
cancer is one of the leading causes of death in
western countries and In India also, lung cancer is
most common in males in all urban registries. The
increasing incidence could be due to increase in
smoking habit, change in life styles of the people,
increased environmental pollution, and at the
same time, due to availability of different modern
diagnostic modalities to detect lung cancer1
Fiberoptic bronchoscopy has an excellent result in
diagnosis of lung cancer when combined with
brushing cytology & biopsy. Bronchoscopy,
followed by brushing and biopsy, in clinically and
radiologically suspected cases, is the main
diagnostic procedure in our contest. Brushing
cytology is considered as an effective tool to
diagnose this condition as it covers wider area (2
cm) compared to less than 5 mm by forceps & it is
easy to obtain brushing cytology sample2.When
biopsy is difficult in certain anatomical location of
the lesions. This
prospective
study
was
conducted
at
Geetanjali
Medical College &
Hospital, Udaipur
over the period
of two year with
the
aim
to
correlate
brushing
cytology
with
biopsy
in
diagnosis
lung
cancer.
Figure 1.Adenocarcinoma Cytology
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METHOD
This prospective study was conducted at
Geetanjali Medical College & Hospital, Udaipur
over the period of Two year. All the cases,
clinically & radiologically suspected of lung cancer,
undergoing brush cytology and bronchial biopsy
done, were included in this study. Bronchoscopy
was performed with flexible bronchoscope in
endoscopy department. Patients with normal
bronchoscopic findings were excluded from study
at this stage. Brushing cytology specimens were
collected. The brush along with adhered cells was
smeared on glass slides & fixed immediately in
95% propanolol and stained with Papanicolaou
stain after fixation. Bronchial biopsy specimens
were collected, biopsy was taken by different
method like bronchial biopsy, CT guided biopsy,
and transthorasic biopsy. The specimens were
fixed with 10% formal saline for 1 day &
processed in automated tissue processor and
sections were prepared and stained with
haematoxylin & eosin stain.
RESULTS
Out of 58 malignant cases, The most common was
the squamous cell carcinoma (Fig.3) (58.62%),
followed by adenocarcinoma (Fig.2) (18.96%),
small
cell
carcinoma
(Fig.6)
(12.06%),
miscellaneous (8.62%) & large cell carcinoma
(1.72%) showing in (Table 2). specimens were
collected over the period of 2 year. cytohistological
Figure 2.Adenocarcinoma Biopsy
ISSN NO- 2230 – 7885
CODEN JPBSCT
NLM Title: J Pharm Biomed Sci.
correlation was done in 58 malignant cases.
Different types of carcinomas diagnosed by brush
cytology are tabulated (Table 1). Among them,
squamous cell carcinoma comprised (fig.4)
48.27%, adenocarcinoma (Fig.1) 8.62%, & small
cell carcinoma (Fig.5) 6.89%. Large cell carcinoma
(1.72%).
Figure 3.Squamous cellcarcinoma–Biopsy.
Figure 4.Squamous cell carcinoma–cytology.
Figure 5.Small Cell Carcinoma- Cytology.
Figure 6.Small Cell Carcinoma- Biopsy.
CORRELATION OF BRONCHIAL BRUSHING
CYTOLOGY AND BIOPSY:
Both bronchial biopsy and brushing cytology were
positive for malignancy in 38 cases. Out of 34
cases, 28 cases were of squamous cell carcinoma,
which were detected by brushing cytology & were
well correlated. 5 out 11of adenocarcinoma, 4 out
of 7 of small cell carcinoma, which were detected
by brushing cytology, one out of one of large cell
carcinoma were detected by brushing cytology.
No miscellaneous case could be detected by brush
cytology and 20 cases out of 58 were given
negative for malignancy which was proved to be
malignant by biopsy.
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DISCUSSION
Bronchoscopy is an important diagnostic modality
in the early diagnosis of lung carcinoma. In
addition to direct visualization of the lesion,
brushing and tissue for histopathological
examination can be obtained. Thus bronchial
brushing has firmly established its role in the early
diagnosis of lung carcinoma because it is safe,
rapid and cost effective and importantly gives a
higher rate of sensitivity and accuracy. However
combination of these modalities gives higher
detection rate for bronchoscopically visible tumor.
Therefore, bronchial brush cytology should be
performed whenever possible in all suspected
cases of lung cancer.
ISSN NO- 2230 – 7885
CODEN JPBSCT
NLM Title: J Pharm Biomed Sci.
Timely detection of the disease plays a pivotal role
in the management & for the long term survival of
the patients. Bronchial brushing cytology is
considered as an effective diagnostic tool for this
condition. Though it is inferior to bronchial biopsy
in histological typing, it is quite safe, less invasive,
economical & provide quick results as compared
to bronchial biopsy2,5,6. It is highly sensitive &
specific procedure as specimen is directly
obtained from the lesion without contamination of
saliva or nasopharyngeal secretion7. In this study,
the most common tumor was squamous cell
carcinoma 58.89%, followed by adenocarcinoma
18.96%, small cell carcinoma 12.06%, large cell
carcinoma 1.72%. In 38 cases, brushing cytology
were well correlated with biopsy which was taken
as a gold standard. There were no cytologically
false positive cases. This tallies with the study
conducted by eva piya et al. according to which
squamous cell carcinoma was the most common
one
comprising
64.2%,
followed
by
adenocarcinoma 18.8%, small cell carcinoma 7%,
large cell carcinoma 1%3. Sayami G et al, according
to which squamous cell carcinoma was the most
common one comprising 64.3%, followed by
adenocarcinoma 17.4%, small cell carcinoma
15.4%, large cell carcinoma 2% carcinoid tumor
0.2%, bronchioalveolar carcinoma 0.2% and
mucoepidermoid carcinoma 0.2%8.
Brushing had a good detection rate for all the
tumor types in this study. It detected 82.35% of
squamous cell carcinoma, 45.45 % of
adenocarcinoma, and 57.14% of small cell
carcinoma.100% of large cell carcinoma. While
biopsy had better detection rate in all cases.
In many studies biopsy had a better detection rate.
In one study done in Nepal Medical College, lung
cancer detection rate of bronchial biopsy was
92.2%, while brushing could detect only 65.2% of
the cases9. Similarly another study conducted by
KA Gaber et al., biopsy had a better detection rate
than brushing cytology ie. 79.4% versus 74.5%10.
However in many studies brushing had a better
detection for the tumor types according to some
study M Matsuda et al. observed that bronchial
brushing had better detection rate (90.3%) than
biopsy(64.8%).Combination of both modalities
yielded
highest
incidence
of
positive
diagnosis((93.7%). It is because brushing covers
the wide area than biopsy and a significant
amount of material can be obtained11. According to
Ashok K et al, also brushing had better detection
rate than biopsy 72% versus 69%12.
Table 1.Types of Carcinomas diagnosed by bronchial brush cytology.
Histological types of carcinomas
Number
Squamous cell carcinoma
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma
Miscellaneous
Negative for malignancy
Total
28
5
4
1
0
20
58
Table 2. Types of carcinomas diagnosed by bronchial biopsy.
Histological types of carcinomas
Number
495
Percentage (%)
48.27
8.62
6.89
1.72
0
34.48
100
Percentage (%)
Squamous cell carcinoma
34
58.62
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma
Miscellaneous
Negative for malignancy
Total
11
7
1
5
0
58
18.96
12.06
1.72
8.62
0
100
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NLM Title: J Pharm Biomed Sci.
Table 3. Comparison between brushing & biopsy.
Biopsy
Negative
0
Total
Brushing Positive
Biopsy
Positive
38
Brushing Negative
20
0
20
Total
58
0
58
CONCLUSION
Lung cancer is one of the major causes of
morbidity & mortality in developing countries.
Bronchial brushing cytology is an inexpensive, less
invasive, quick and effective diagnostic tool in
detection of lung cancer and it can diagnose lung
cancers where bronchoscopic biopsy is technically
not feasible or not interpretable. It is highly
sensitive procedure. It has insignificant false
positive or negative results, so at advanced stage it
can be the only important & time saving
preoperative diagnostic tool in our contest.
Though biopsy had better detection rate than
brushing (because here in this study different
biopsy method are available for comparison, so
that several technical difficulties e.g. stenosis,
bleeding, peripheral location of tumor are
overwhelmed and biopsy give better result).
However combination of these modalities gives
higher detection rate for bronchoscopically visible
tumor.
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Copyright © 2014 Pancharia A, Yadav V, Taneja C, Chauhan S, Chauhan R, Gauttam V. This is an open access article distributed under
the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provi ded the
original work is properly cited.
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