Does a routine post brush bronchial wash increase the yield in diagnosis of lung cancer?

Mathan Raj S., Sowmiya Murali


Background: Lung cancer is the most common cause of cancer-related death in both men and women. 80% of the lung cancers are non-small cell lung cancer (NSCLC) and 20% are small cell lung cancer (SCLC). Flexible fiberoptic bronchoscopy is commonly used for diagnostic and staging purposes. Endoscopically visible abnormalities are approached with traditional biopsy forceps, brushings, and washings. Objectives were to assess the yield of bronchial washings, brush cytology and to compare the yield of pre and post brush bronchial washings.

Methods: Patients with suspicion of lung cancer will be subjected to bronchoscopy using flexible fibreoptic bronchoscopy. Multiple procedures performed for the retrieval of tissue samples will include bronchial washings (pre and post brushing), bronchial brushing and endobronchial biopsy.

Results: A total of 57 cases were included in the study with 40 (70.2%) males and 17 females (29.8%). The yield of pre-brush bronchial washings, post brush bronchial washings and bronchial brushings were 31.6% (18 of 57), 31.6% (18 of 57) and 61.4% (35 of 57) respectively. Biopsy was positive for malignancy in 11 of 19 (58.2%) cases. Adenocarcinoma was the commonest type seen in 32 (56.1%) patients. Of the 27 cases with endobronchial growth 11 were adenocarcinoma (40.7%).

Conclusions: There was no difference between the yield of pre-brush washing and post brush washing. The yield of brush cytology was significantly more than the yield of bronchial washings. There is an increase in the yield after adding both pre and post brush bronchial wash.



Adenocarcinoma, Bronchial brushing, Bronchial washings, Endobronchial biopsy, Flexible fiberoptic bronchoscopy

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World Cancer Research Fund, American Institute for Cancer Research. Food, nutrition and the prevention of cancer: a global perspective. Washington, DC: American Institute for Cancer Research; 1997:37-45.

Rosen G. A history of public health (expanded). Baltimore, Md: The Johns Hopkins university press; 1993.

Arroliga AC, Matthay RA. The role of bronchoscopy in lung cancer. Clin Chest Med. 1993;14:87-98.

Kamath AV, Chhajed PN. Role of bronchoscopy in early diagnosis of lung cancer. Indian J Chest Dis Allied Sci. 2006;48(4):265-9.

Gasparini S. Bronchoscopic biopsy techniques in the diagnosis and staging of lung cancer. Monaldi Arch Chest Dis. 1997;52:392-8.

Jindal SK, Behera D, Dhand R, Kashyap S, Malik SK. Flexible fiberoptic bronchoscopy in clinical practice: a review of 100 procedures. Indian J Chest Dis Allied Sci. 1985;27:153-8.

Prasad R, James P, Kesarwani V, Gupta R, Mohan C. Clinicopathological study of bronchogenic carcinoma. Respirology. 2004;9:557-60.

Sharma CP, Behera D, Aggarwal AN, Gupta D, Jindal SK. Radiographic patterns in lung cancer. Indian J Chest Dis Allied Sci. 2002;44:25-30.

Behera D, Balamugesh T. Lung Cancer in India. Indian J Chest Dis Allied Sci. 2004;46:269-81.

Jussawala DJ, Jain DK. Lung cancer in greater Bombay correlation with religion and smoking habits. Br J Cancer. 1979;40:437-48.

Rapiti E, Jindal SK, Gupta D, Boffetta P. Passive smoking and lung cancer in Chandigarh, India. Lung Cancer. 1999;23:183-9.

Smith RA, Glynn TJ. Epidemiology of lung cancer. Radiol Clin N Am. 2000;38(3):453-70.

Behera D, Balamugesh T. Lung cancer in India. Indian J Chest Dis Allied Sci. 2004;46:269-81.

Akira F, Browne TK, Houser WC, Hranicka LJ. Diagnostic value of bronchial aspirate and post bronchoscopic sputum in firboeroptic bronchoscope. Chest. 1979;76(5):514-7.

Win R, Smitha PS. Aetiology of haemoptysis in patients presenting to a tertiary care centre in South India. J Evol Med Dent Sci. 2017;1(6):765-9.

Karahalli E, Yilmaz A, Türker H, Ozvaran K. Usefulness of various diagnostic techniques during fibreoptic bronchoscopy for endoscopically visible lung cancer: Should cytologic examinations be performed routinely? Respiration. 2001;68:611-4.

Kvale PA, Johnson MC, Wroblewski DA. Diagnosis of tuberculosis: routine cultures of bronchial washings are not indicated. Chest. 1979;76(2):140-2.

Van der Drift MA, van der Wilt GJ, Thunnissen FB, Janssen JP. A Prospective study of the timing and cost-effectiveness of bronchial washing during bronchoscopy for pulmonary malignant tumors. Chest. 2005;128(1):394-400.

Sompradeekul S, Chinvetkitvanich U, Suthinon P, Wongbunnate S. Difference in the yields of bronchial washing cytology before and after forceps biopsy for lung cancer diagnosis. J Med Assoc Thailand. 2006;89(5):37-45.

Chau CH, Yew WW, Wong PC, Lee J, Wong CF. Usefulness of collecting routine cytological specimens during fiberoptic bronchoscopy for endoscopically visible and nonvisible lung carcinoma. Chest. 1997;111:522-3.

Solomon DA, Solliday NH, Gracey DR. Cytology in fiberoptic bronchoscopy: comparison of bronchial brushing, washing and post-bronchoscopu sputum. Chest. 1974;65:616-9.

Gaur DS, Thapliyal NC, Kishore S, Pathak VP. Efficacy of broncho-alveolar lavage and bronchial brush cytology in diagnosing lung cancers. J Cytol. 2007;24:73-7.

Govert JA, Dodd LG, Kussin PS. A prospective comparison of fiberoptic transbronchial needle aspiration and bronchial biopsy for bronchoscopically visible lung carcinoma. Cancer. 1999;87:129-34.