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Does the Sequence of Sample Collection Alter the Yield of Fiberoptic Bronchoscopy in Patients With Suspected Malignancy?

Academic, Scott and White Clinic and Hospital, Texas A & M Health Science Center, Temple, TX

PURPOSE: Fiberoptic Bronchoscopy has been used to evaluate patients with suspected malignancy for many years. Specimen collection typically includes bronchial washings, bronchial brushings, and transbronchial biopsies. The goal of our study was to determine if there is an optimal order of specimen collection.

METHODS: Patients referred for bronchoscopic evaluation of possible malignancy were stratified according to the presence or absence of an endobronchial abnormality. They were then prospectively randomized to one of three experimental arms: Wash/Brush/Biopsy, Brush/Wash/Biopsy, and Brush/Biopsy/Wash. Data recorded included patient demographics, lesion size and location, final diagnosis with method of determination, and complications.

RESULTS: 141 patients were randomized of which fifty-five patients had visible endobronchial lesions. Bronchoscopy yielded a diagnosis in 63% of patients without endobronchial lesions and in 82% of patients with visible lesions. There was no significant difference between the yield of the three sampling orders in the visible endobronchial lesion or non-visible lesion groups. In patients with no visible lesion, bronchial washing yielded a diagnosis of malignancy in 17%, bronchial brushing yielded a diagnosis in 34%, and transbronchial biopsy yielded a diagnosis in 24%. In patients with a visible lesion, bronchial washing yielded a diagnosis in 23%, mucosal biopsy yielded a diagnosis in 70%, and bronchial brushing yielded a diagnosis in 50% of patients. The diagnosis of a malignant lesion was never made solely on the basis of the cytologic evaluation of bronchial washing. Complications included two patients with bradycardia and hypotension, four patients with ventilatory insufficiency, and one patient with bronchospasm. There were no deaths in this study.

CONCLUSIONS: Altering the sequence of sample collection does not alter the yield in patients undergoing fiberoptic bronchoscopy for suspected malignancy. Bronchial washing cytology is of minimal utility in patients with suspected malignancy.

CLINICAL IMPLICATIONS: Bronchial washing cytology has relatively low yield in the diagnosis of malignancy and may not be necessary during bronchoscopy for patients with suspected malignancy.

DISCLOSURE: V.J. Test, Scott, White, Sherwood, and Brindley Foundation, University monies.