The optimal sequence of bronchial brushing and washing for diagnosing peripheral lung cancer using non-guided flexible bronchoscopy

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作者
Jun Hyeok Lim
Min Jeong Kim
Sang-Hoon Jeon
Mi Hwa Park
Woo Youl Kim
Minkyung Lee
Jun Ho Kim
Jung Soo Kim
Young Sam Kim
Lucia Kim
Kyung-Hee Lee
Seung Min Kwak
Hyekyung Shin
Hae-Seong Nam
机构
[1] Inha University Hospital,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
[2] Inha University School of Medicine,Department of Nuclear Medicine
[3] Inha University Hospital,Department of Radiology
[4] Inha University School of Medicine,Department of Thoracic Surgery
[5] Inha University Hospital,Department of Pathology
[6] Inha University School of Medicine,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
[7] Inha University Hospital,undefined
[8] Inha University School of Medicine,undefined
[9] Inha University Hospital,undefined
[10] Inha University School of Medicine,undefined
[11] Incheonsarang Hospital,undefined
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摘要
The optimum sequence of bronchial brushing and washing for diagnosing peripheral lung cancer, defined as an invisible endobronchial tumour, is not clear and requires further study. We prospectively obtained washing samples after brushing in patients with peripheral lung tumours during non-guided flexible bronchoscopy (FB) to investigate the diagnostic yield of these samples and conducted a retrospective review of the prospectively collected data. The study included 166 patients who met the inclusion criteria. The overall diagnostic yield of bronchial brushing and washing for peripheral lung cancer was 52.4%. The diagnostic yields of brushing and washing were 37.3% and 46.4%, respectively, and that of washing was superior according to McNemar’s test (p = 0.017, κ = 0.570). Furthermore, washing was diagnostic, whereas brushing was not, in 15.1% of all cases. Comparison of positive washing cytology (brushing) with the respective pathological diagnosis yielded a concordance rate of 88.3% (90.3%), with κ = 0.769 (0.801) (p < 0.001). Performing washing after brushing during non-guided FB is a very safe, cost-effective procedure that may help improve the diagnostic yield in patients with suspected peripheral lung cancer. Our information will also benefit clinicians performing diagnostic bronchoscopy in patients with suspected peripheral lung cancer when fluoroscopic guidance or advanced bronchoscopy techniques are not available.
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