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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Aspiration of bronchial wash fluid is commonly used in conjunction with brushing and forceps biopsy to diagnose endoscopically visible lung cancer&#46; However&#44; the optimal sequence of these procedures is subject to debate&#46; 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&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">A prospective&#44; cross-sectional study was carried out on patients with endoscopically visible lung cancer who underwent video-assisted fiberoptic bronchoscopy for diagnostic purposes&#46; Aspiration of bronchial wash fluid was performed on all patients both before and after bronchial brushing and forceps biopsy&#46; The results were analyzed separately for each type of endobronchial lesion and for both together&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The study included 75 patients&#44; with a mean age of 63&#46;3 years&#59; 81&#37; were men&#46; Bronchoscopy was diagnostic in 71 &#40;94&#46;7&#37;&#41; cases&#46; Findings from bronchial washing fluid were positive in 40 &#40;53&#46;3&#37;&#41; patients when washing was performed prior to brushing and forceps biopsy&#59; when washing was performed after these procedures&#44; findings were positive in 43 &#40;57&#46;3&#37;&#41; patients &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;6&#41;&#46; The combined diagnostic yield of washing before and after brushing and forceps biopsy was 69&#46;3&#37;&#44; a significantly better result than either washing before &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41; or after &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;004&#41; the other sampling techniques&#46; In cases where findings from washing done after brushing and forceps biopsy were negative &#40;14 of 32&#44; 43&#46;7&#37;&#41;&#44; blood in the aspirated sample interfered with cytology&#46; In comparison&#44; when washing was performed prior to brushing and biopsy&#44; that problem arose in only 3 of the 35 cases &#40;8&#46;5&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;002&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The order in which bronchial washing is performed in relation to other sampling techniques for diagnosing bronchial tumors does not influence the diagnostic yield&#46; This is probably because the aspirated fluid sample is more likely to contain excessive blood when washing is performed after brushing and forceps biopsy&#46; However&#44; the diagnostic yield can be significantly increased by combining the findings from bronchial washings performed both before and after other sample collection procedures&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Adem&#225;s del cepillado y de la biopsia bronquiales&#44; el aspirado bronquial &#40;AB&#41; es una t&#233;cnica utilizada habitualmente en el diagn&#243;stico del c&#225;ncer de pulm&#243;n endosc&#243;picamente visible&#46; Existe controversia sobre el momento adecuado para su realizaci&#243;n&#46; El objetivo del presente estudio ha sido evaluar si el momento de la realizaci&#243;n del AB puede influir en el rendimiento diagn&#243;stico&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha llevado a cabo un estudio transversal prospectivo&#44; en el que se incluy&#243; a pacientes con carcinomas broncog&#233;nicos endosc&#243;picamente visibles a los que se hizo una videofibrobroncoscopia con fines diagn&#243;sticos&#46; A todos se les realizaba AB previo y tras el cepillado y la biopsia bronquiales&#46; El resultado se analiz&#243; de forma global y para cada tipo de lesi&#243;n endobronquial&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 75 pacientes con una edad media de 63&#44;3 a&#241;os siendo el 81 &#37; varones&#46; La broncoscopia fue diagn&#243;stica en 71 &#40;94&#44;7&#37;&#41;&#46; El AB previo fue positivo en 40 pacientes &#40;53&#44;3&#37;&#41; y el posterior en 43 &#40;57&#44;3&#37;&#41; &#40;p &#61; 0&#44;6&#41;&#46; La rentabilidad conjunta de ambos fue del 69&#44;3&#37;&#44; significativamente superior a la del AB previo &#40;p &#61; 0&#44;001&#41; y la del AB posterior &#40;p &#61; 0&#44;004&#41; por separado&#46; En el 43&#44;7&#37; de los casos en que el AB posterior fue negativo&#44; la valoraci&#243;n citol&#243;gica se vio dificultada por ser muy hem&#225;tica&#44; frente al 8&#44;5&#37; de los AB previos negativos &#40;p &#61; 0&#44;002&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">El orden de la realizaci&#243;n del AB en el diagn&#243;stico de neoplasias bronquiales no influye en el rendimiento diagn&#243;stico&#44; probablemente por la mayor frecuencia de AB hemorr&#225;gicos que se producen cuando el AB se realiza tras el cepillado y la biopsia bronquiales&#46; El estudio conjunto de ambos AB incrementa significativamente el rendimiento diagn&#243;stico de la t&#233;cnica&#46;</p>"
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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
Visits
6945
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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Article information
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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