Bronchial brushing and biopsy : comparison of diagnostic yield in lung cancer patients at King Hussein Medical Center

Abstract EN

Objective: This study assessed the diagnostic yield of bronchial biopsy and bronchial brush, obtained through fibreoptic bronchoscopy, in patients with a visible endobronchial tumor diagnosed at King Hussein Medical Center (KHMC).

Methods: This prospective study included 114 patients who were referred for fibreoptic bronchoscopy in the bronchoscopy unit at KHMC to evaluate suspicious lung masses between June 2016 and January 2019.

Inclusion criteria were: age > 14 years and radiological evidence of a lung mass.

Exclusion criteria were: patients who did not have a visible endobronchial tumor during fibreoptic bronchoscopy or who were found not to be fit for bronchoscopy due to medical reasons.

Through fibreoptic bronchoscopy, bronchial forceps biopsies followed by bronchial brush were obtained and then sent for histological and cytological study.

At least five bronchial biopsy samples from the tumor were taken.

Biopsy or brush results that showed suspicious cells suggestive of malignancy were considered non-diagnostic and were regarded as negative for malignancy in our study.

We reviewed the results obtained by bronchial forceps biopsy and by bronchial brushing and compared the diagnostic yield of each one of them separately.

Subsequently, we examined the yield when both techniques were combined in diagnosing lung cancer.

Results: Out of the 114 patients enrolled in our study, 87 (76.3%) were male and 27 (23.7%) were female.

The mean age ± standard deviation was 64 ± 9.2 years (males) and 60.1 ± 12.9 years (females).

Bronchial biopsy was positive in 91 patients (79.8%), while bronchial brush was positive in 30 patients (26.3%).

Bronchial biopsy and bronchial brush were both positive in 29 cases (25.4%).

Bronchial brush was the only positive result in 1 case (0.9%), while bronchial biopsy was the only positive result in 62 cases (54.4%).

Both techniques were negative in 22 cases (19.3%).

The overall positive diagnosis using both techniques was 80.7% (92 cases).

The most common tumor type diagnosed by bronchial biopsy was squamous cell carcinoma, followed by small cell carcinoma.

On the other hand, adenocarcinoma was the most common cytological diagnosis obtained by bronchial brush, followed by squamous cell carcinoma.

Conclusion: In our study, diagnostic fibreoptic bronchoscopy was a sensitive method for diagnosing visible endobronchial lung tumors.

Bronchial biopsy was more sensitive in diagnosing lung tumors compared to bronchial brushing.

Combining both techniques did not significantly improve the diagnostic yield.

Future studies regarding the causes of low sensitivity of bronchial brush in our hospital should be performed in order to improve the bronchial brush diagnostic yield.