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Vol. 42. Issue 6.
Pages 278-282 (June 2006)
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Vol. 42. Issue 6.
Pages 278-282 (June 2006)
Original Articles
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Effect of Different Bronchial Washing Sequences on Diagnostic Yield in Endoscopically Visible Lung Cancer
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Alberto Fernández-Villara,
Corresponding author
jfv01po@saludalia.com

Correspondence: Dr. A. Fernández-Villar. Joaquín Costa, 60, 6.° C. 36004 Pontevedra. España
, Ana Gonzálezb, Virginia Leiroa, Cristina Represasa, María Isabel Botanaa, Purificación Blancoa, Mar Mosteiroa, Luis Piñeiroa
a Servicio de Neumología, Hospital Xeral-Cíes, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
b Servicio de Anatomía Patológica, Hospital Xeral-Cíes, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
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Objective

Aspiration of bronchial wash fluid is commonly used in conjunction with brushing and forceps biopsy to diagnose endoscopically visible lung cancer. However, the optimal sequence of these procedures is subject to debate. The objective of this study was to determine if the order in which bronchial washing is performed relative to bronchial brushing and forceps biopsy has any effect on the diagnostic yield.

Patients and methods

A prospective, cross-sectional study was carried out on patients with endoscopically visible lung cancer who underwent video-assisted fiberoptic bronchoscopy for diagnostic purposes. Aspiration of bronchial wash fluid was performed on all patients both before and after bronchial brushing and forceps biopsy. The results were analyzed separately for each type of endobronchial lesion and for both together.

Results

The study included 75 patients, with a mean age of 63.3 years; 81% were men. Bronchoscopy was diagnostic in 71 (94.7%) cases. Findings from bronchial washing fluid were positive in 40 (53.3%) patients when washing was performed prior to brushing and forceps biopsy; when washing was performed after these procedures, findings were positive in 43 (57.3%) patients (P=.6). The combined diagnostic yield of washing before and after brushing and forceps biopsy was 69.3%, a significantly better result than either washing before (P=.001) or after (P=.004) the other sampling techniques. In cases where findings from washing done after brushing and forceps biopsy were negative (14 of 32, 43.7%), blood in the aspirated sample interfered with cytology. In comparison, when washing was performed prior to brushing and biopsy, that problem arose in only 3 of the 35 cases (8.5%) (P=.002).

Conclusions

The order in which bronchial washing is performed in relation to other sampling techniques for diagnosing bronchial tumors does not influence the diagnostic yield. This is probably because the aspirated fluid sample is more likely to contain excessive blood when washing is performed after brushing and forceps biopsy. However, the diagnostic yield can be significantly increased by combining the findings from bronchial washings performed both before and after other sample collection procedures.

Key words:
Fiberoptic bronchoscopy
Lung cancer
Endobronchial lesion
Bronchial lavage fluid
Cytology
Objetivo

Además del cepillado y de la biopsia bronquiales, el aspirado bronquial (AB) es una técnica utilizada habitualmente en el diagnóstico del cáncer de pulmón endoscópicamente visible. Existe controversia sobre el momento adecuado para su realización. El objetivo del presente estudio ha sido evaluar si el momento de la realización del AB puede influir en el rendimiento diagnóstico.

Pacientes y métodos

Se ha llevado a cabo un estudio transversal prospectivo, en el que se incluyó a pacientes con carcinomas broncogénicos endoscópicamente visibles a los que se hizo una videofibrobroncoscopia con fines diagnósticos. A todos se les realizaba AB previo y tras el cepillado y la biopsia bronquiales. El resultado se analizó de forma global y para cada tipo de lesión endobronquial.

Resultados

Se incluyó a 75 pacientes con una edad media de 63,3 años siendo el 81 % varones. La broncoscopia fue diagnóstica en 71 (94,7%). El AB previo fue positivo en 40 pacientes (53,3%) y el posterior en 43 (57,3%) (p = 0,6). La rentabilidad conjunta de ambos fue del 69,3%, significativamente superior a la del AB previo (p = 0,001) y la del AB posterior (p = 0,004) por separado. En el 43,7% de los casos en que el AB posterior fue negativo, la valoración citológica se vio dificultada por ser muy hemática, frente al 8,5% de los AB previos negativos (p = 0,002).

Conclusiones

El orden de la realización del AB en el diagnóstico de neoplasias bronquiales no influye en el rendimiento diagnóstico, probablemente por la mayor frecuencia de AB hemorrágicos que se producen cuando el AB se realiza tras el cepillado y la biopsia bronquiales. El estudio conjunto de ambos AB incrementa significativamente el rendimiento diagnóstico de la técnica.

Palabras clave:
Fibrobroncoscopia
Carcinoma broncogénico
Lesión endobronquial
Aspirado bronquial
Citología
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REFERENCES
[1]
P Mazzone, P Jain, AC Arroliga, RA Matthay.
Bronchoscopy and needle biopsy techniques for diagnosis and staging of lung cancer.
Clin Chest Med, 23 (2002), pp. 137-158
[2]
E Martínez Moragón, J Aparicio Urtasun, J Sanchís Aldás, A de Diego Damiá, M Martínez Francés, E Cases Viedma, et al.
Fibrobroncoscopia en el cáncer de pulmón: relación entre radiología, endoscopia, histología y rendimiento diagnóstico en una serie de 1.801 casos.
Arch Bronconeumol, 30 (1994), pp. 291-296
[3]
VHF Mark, ID Johnston, MR Hetzel, C Grubb.
Value of washing and brushings of fiberoptic bronchoscopy in the diagnosis of lung cancer.
Thorax, 45 (1990), pp. 373-376
[4]
JA Govert, JM Kopita, D Matchar, PS Kussin, WH Samuelson.
Cost-effectiveness of collecting routine cytologic specimens during fiberoptic bronchoscopy for endoscopically visible lung tumor.
Chest, 109 (1996), pp. 451-456
[5]
E Karahalli, A Yilmaz, H Türker, K Özvaran.
Usefulness of various diagnostic techniques during fiberoptic bronchoscopy of endoscopically visible lung cancer: should cytologic examinations be performed routinely?.
Respiration, 68 (2001), pp. 611-614
[6]
R Ramí, JL Duque, JR Hernández, J Sánchez de Cos, Grupo de Trabajo SEPAR.
Normativa actualizada sobre diagnóstico y estadificación del carcinoma broncogénico.
Arch Bronconeumol, 34 (1998), pp. 437-452
[7]
G Schreiber, DC McCrory.
Performance characteristics of different modalities for diagnosis of suspected lung cancer.
Chest, 123 (2003), pp. 115-128
[8]
British Thoracic Society.
British Thoracic Society guidelines on diagnostic flexible bronchoscopy.
Thorax, 56 (2001), pp. 1-21
[9]
J Castella.
Broncoscopia general.
Medicina respiratoria, 2nd ed., pp. 409-427
[10]
UBS Prakash.
Bronchoscopic specimen collection: is there a proper order of sequence.
J Bronchol, 9 (2002), pp. 269-271
[11]
FYW Lee, AC Metha.
Basic techniques in flexible bronchoscopy.
Flexible bronchoscopy, pp. 95-118
[12]
D Yick, N Kamangar, JM Wallace.
Noninvasive bronchoscopic specimens in the diagnosis of lung cancer.
J Bronchol, 8 (2001), pp. 301-308
[13]
BA Chaudhary, K Yoneda, NK Burki.
Fiberoptic bronchoscopy: comparison of procedures used in the diagnosis of lung cancer.
J Thorac Cardiovasc Surg, 76 (1978), pp. 33-37
[14]
AC Metha.
Wash or not to wash, brush or not to brush. That is the question.
J Bronchol, 7 (2001), pp. 293-294
[15]
Papanicolaou Society of Cytopathology Task Force on Standards Practice.
Guidelines of the Papanicolaou Society of Cytologic specimens obtained from the respiratory tract.
Diagn Cytopathol, 21 (1999), pp. 61-69
[16]
M Yigla, D Nagiv, A Solomonov, E Malderger, O Ben-Izhak, AE Rubin, et al.
Timing of collecting bronchoscopic cytologic specimens in endobronchial malignant neoplasms.
J Bronchol, 9 (2002), pp. 272-275
[17]
MA van der Drift, G van der Wilt, FBJM Thumissen, JP Janssen.
A prospective study of the timing and cost-effectiveness of bronchial washing during bronchoscopy for pulmonary malignant tumors.
Chest, 128 (2005), pp. 394-400
[18]
NJ Raymond, S McLeod, PE Thornley.
Timing of bronchial washing at fibrebronchoscopy improves the diagnostic rate of primary bronchial carcinoma.
Thorax, 46 (1991), pp. 289
[19]
NA Scriven, JT MacFarlane, CA Clelland.
Bronchial washings: when should we do them?.
Thorax, 54 (1999), pp. 84
[20]
VJ Test, WG Petersen.
Does the sequence of sample collection alter the yield of fiberoptic bronchoscopy in patients with suspected malignancy.
Chest, 124 (2003), pp. 78
[21]
G Eather, R Nickels, J Feenstra, J Armstrong, M Turner, L Garske.
The effect of altering the sequence order of saline washing in the bronchoscopic diagnosis of lung cancer. Abstract of 2005 Annual Scientific Meeting of the Thoracic Society of Australia and New Zealand. Accessed on August 28, 2005.
[22]
C Disdier, F Rodríguez de Castro.
Punción transbronquial aspirativa.
Arch Bronconeumol, 36 (2000), pp. 580-593
[23]
JA Gullón, R Fernández, A Medina, G Rubinos, I Suárez, C Ramos, et al.
Punción transbronquial en el carcinoma broncogénico con lesión visible: rendimiento y coste económico.
Arch Bronconeumol, 39 (2003), pp. 496-500
[24]
JR Goellner.
Evaluation of the cellular sample.
Comprehensive cytopathology, 2nd ed., pp. 69-74
Copyright © 2006. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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