Kakodkar Uday C, Vadala Rohit, Mandrekar Suresh
Assistant Professor, Department of Pulmonary Medicine, Goa Medical College , Bambolim -Goa, India .
Senior Resident, Department of Pulmonary Medicine, Goa Medical College , Bambolim -Goa, India .
J Clin Diagn Res. 2016 Apr;10(4):OC25-8. doi: 10.7860/JCDR/2016/15911.7634. Epub 2016 Apr 1.
Bronchoscopy is a safe & effective means of diagnosing bronchogenic carcinoma with a varying diagnostic yield of different bronchoscopic procedures. Cell-Block (CB) preparation of cytology specimen has been shown to increase the diagnostic yield further. To the authors' knowledge, the diagnostic value of CB as an adjunct to conventional smear cytology (CS) of bronchial washing specimens in the detection of bronchogenic carcinoma has not been well evaluated.
The present study was aimed to evaluate the diagnostic utility of CB of bronchial washings when compared with CS.
A total of 104 patients of suspected bronchogenic carcinoma were subjected to bronchoscopy as per British Thoracic Society (BTS) protocol. Bronchial biopsy, brushings and washings were collected. Smears were prepared immediately of bronchial washings and another aliquot was subjected to CB preparation and further processing by paraffin embedding and H&E staining.
Out of 104 patients, 92 were diagnosed by bronchoscopy with a cumulative diagnostic yield of all sampling techniques being 88.46%. Yield of CB of bronchial washings (44.23%) was higher than Bronchial washings - conventional smears (36.53%). CB detected additional 8 cases of malignancy where corresponding bronchial washings-conventional smears were negative. Exclusive diagnosis by CB was obtained in 2 cases. Brushings and biopsy confirmed malignancy in 49.03% and 57.69% cases.
CB of bronchial washings had a higher yield as compared to corresponding conventional smears. Increase in yield was also noted when CB of bronchial washings was combined with biopsy and compared to bronchial washings- conventional smears combined with biopsy. In limited resource settings, CB preparation is a simple method that increases diagnostic yield of flexible bronchoscopy, is cost effective & hence can be routinely used. The immunohistochemical and molecular studies are possible with CB only, which is a distinct advantage over conventional smears of bronchial washings.
支气管镜检查是诊断支气管源性癌的一种安全有效的方法，不同支气管镜检查程序的诊断率各不相同。细胞学标本的细胞块（CB）制备已被证明能进一步提高诊断率。据作者所知，CB作为支气管冲洗标本常规涂片细胞学（CS）的辅助手段在检测支气管源性癌中的诊断价值尚未得到充分评估。
本研究旨在评估支气管冲洗液CB与CS相比的诊断效用。
按照英国胸科学会（BTS）方案，对总共104例疑似支气管源性癌患者进行支气管镜检查。收集支气管活检组织、刷检物和冲洗液。支气管冲洗液立即制备涂片，另一部分进行CB制备，并通过石蜡包埋和苏木精-伊红染色进一步处理。
104例患者中，92例通过支气管镜检查确诊，所有采样技术的累积诊断率为88.46%。支气管冲洗液CB的诊断率（44.23%）高于支气管冲洗液常规涂片（36.53%）。CB检测出另外8例恶性肿瘤，而相应的支气管冲洗液常规涂片为阴性。2例通过CB获得了明确诊断。刷检和活检在49.03%和57.69%的病例中确诊为恶性肿瘤。
支气管冲洗液CB的诊断率高于相应的常规涂片。当支气管冲洗液CB与活检联合使用时，与支气管冲洗液常规涂片联合活检相比，诊断率也有所提高。在资源有限的情况下，CB制备是一种简单的方法，可提高柔性支气管镜检查的诊断率，具有成本效益，因此可常规使用。只有CB可进行免疫组织化学和分子研究，这是相对于支气管冲洗液常规涂片的一个明显优势。
