[Bronchological bioptic diagnosis of lung cancer -- cytology and/or histology?].

INTRODUCTION: Bronchial carcinomas are commonly diagnosed through histological analysis of forceps biopsies. The use of flexible bronchoscopic biopsy techniques has led to an increase in the number of cytological investigations. The present study has the aim to assess the diagnostic efficiency of histology, cytology and their combined use.
METHOD: In a retrospective analysis, 3630 cytological and/or histological samples that had been obtained bronchoscopically between 1/97 and 12/03 prior to surgery in 1436 patients, who were operated due to bronchial carcinoma, were compared to corresponding histological findings in the resected material.
RESULTS: In 1888 preoperatively analysed areas the resected material ultimately allowed the detection of malignant lesions. Among these cases, histologic analysis of forceps biopsies yielded 399, cytological analysis 728, and their combined use 801 correct diagnoses prior to surgery. The combination of both procedures led to an increase of sensitivity by 16 % and 13.0 % compared to histology and cytology, respectively, as separate procedures. Histologically there were 149 cases, cytologically 1061 cases, and in combination 1040 cases that were falsely diagnosed as negative prior to surgery. The use of histology and/or cytology allowed to correctly detect 1250 areas of the resected material as free of malignant lesions. Specificity was 99.8 % for both methods.
CONCLUSION: Currently bronchial carcinomas are often diagnosed preoperatively by minimally invasive cytological procedures. The present results demonstrate cytology and histology to be procedures that are complementary to each other. Their combined use offered the greatest diagnostic yield and therefore should be considered standard in the diagnosis of bronchial carcinoma.