On site evaluation of biopsy smears in respiratory samples for the diagnosis of lung cancer

Abstract

Introduction: The serum smear of the bronchial biopsy was shown to improve the diagnostic performance of bronchoscopy in endobronchial tumors by 4.8% (Rosell et al. Eur Respir J. 1998), but its result is not immediate.

Objective: to study the feasibility of smear cytology of different types of bronchoscopic and transthoracic biopsies with microscopic on-site evaluation (MOSE), in patients with suspected lung cancer.

Methods: Prospective study from biopsy samples obtained by transbronchial biopsy (TBB), endobronchial biopsy, and thoracic ultrasound-guided tru-cut. MOSE was performed by cytotechnics and cytologist. In 7 of 11 cases (63.6%) the evaluation was done by telecytology.

Results: 18 patients were included. Radial EBUS-guided BTB was performed in 5, bronchial biopsies in 4, Archimedes®️-guided BTB in 3, fine bronchoscope in 2, and thoracic ultrasound-guided lung or mediastinal mass tru-cut in 4. The MOSE of the biopsy smear was positive in 14 cases, suspicious in 1, uncertain in 1, and negative in 2.

The MOSE was coincident with the biopsy smear in 15/18 cases (83.3%). In one case the MOSE was negative while the final result was carcinoma, in another case it was positive and the final smear reported few suspicious atypical cells, and in the third it was suspicious showing malignant cells suggestive of adenocarcinoma in the cytology.

In one case (5.6%) the biopsy smear was diagnostic of squamous cell carcinoma while the biopsy only showed necrosis and atypia.

Conclusions: Performing biopsy smears with MOSE in different types of respiratory samples is a feasible technique for its performance in the clinical practice. In 83% of the samples, it corresponded to the definitive cytological result.