SECT
'iON
B
Cytology of Other Body Sites
CHAPTER
13
Respiratory Tract
William W Johnston and Craig E Elson
Contents
In tro d u c tio n
C y t o lo g y o f L u n g C a n c e r
S a m p lin g a n d C y to p re p a ra to ry T e c h n iq u e s
S q u a m o u s C e ll C a r c in o m a
S p u t u m
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F in e - N e e d le A s p ir a t io n
A n a to m y a n d H is to lo g y
A d e n o s q u a m o u s C a r c in o m a
C y t o lo g y o f N o rm a l a n d B e n ig n C o m p o n e n ts
A d e n o id C y s tic C a rc in o m a
C y t o lo g y o f N o r m a l E p ith e lia l C e lls
O t h e r P r im a r y N e o p la s m s o f t h e L u n g
C y t o lo g y o f A b n o r m a l E p ith e lia l C e lls
N e o p la s m s M e t a s t a t ic t o t h e L u n g
O t h e r C e llu la r C o m p o n e n t s
D ia g n o s t ic A c c u ra c y
N o n c e llu la r In a n im a t e C o m p o n e n t s
S e n s it iv it y a n d S p e c ific ity o f S p e c im e n s o f S p u t u m a n d B ro n c h ia l M a te r ia l
C y t o lo g y o f R e s p ira to ry In fe c tio n s
C o r r e la t io n b e t w e e n S p u t u m a n d B ro n c h ia l C y t o lo g ic S p e c im e n s a n d t h e H is to lo g ic
V ira l In fe c tio n s
S p e c im e n
B a c te ria l In fe c tio n s
F u n g a l In fe c tio n s
C o r r e la t io n b e t w e e n F in e - N e e d le A s p ir a t io n a n d H is to lo g y
P a ra s itic In fe c tio n s
C o m p a iis o n o l th e D ia g n o s tic A c c u ia c y o l S p u t u m a n d B io n c h ia l M a t e iia l
a n d F in e - N e e d le A s p ir a te s
In c o n c lu siv e C y t o lo g ic S p e c im e n
C o n c lu d in g R e m a rk s
P a th o lo g y o f L u n g C a n c e r
Introduction
In the introduction to his famous 1954
Atlas of Exfoliative
Cytology,
George N. Papanicolaou comments,
During the past decade much progress has been made in the
adaptation of the cytologic method to the diagnosis of cancer.
This is attested by the expanding use of the method of cover,
a greater number of organs and by its rapidly increasing
utilization in diagnostic laboratories in this country and
abroad.
Later in his chapter on the respiratory system, he notes further,
The use of the cytologic method in the diagnosis of malignant
lesions of the respiratory tract has been generally acclaimed
as one of its most successful applications. Statistics show that
its diagnostic accuracy is higher than that of bronchoscopy.
The cytologic method may indeed provide not only an accurate
diagnosis of a malignant neoplasm but often recognition of its
type.1
These highly prophetic words were reflected in the studies
published during the 1950s and 1960s, a remarkably fertile
period of development for respiratory cytology. Many pub-
lications reported new techniques, detection of neoplastic
cells, and cytohistologic correlations. The studies by Archer
and colleagues,2 Wandall,3 Hampson,4 Bamforth,5 Grunze,6
Russell and associates,7 Woolner and co-workers,8 McDon-
ald,9 Papanicolaou and colleagues,10 Farber and associates,11
Clerf and Herbut,12 Herbut,13 Foot,14 Umiker,15 Richardson and
colleagues,16 Koss and co-workers,17 Spjut and co-workers,18 and
von Haam19 were significant contributions among these early
investigations.
During the same period, significant developments were
also occurring in transthoracic needle biopsy studies, although
studies were not quite as profuse at those involving sputum and
bronchial material. The Dahlgren and Nordenstrom monograph
on transthoracic needle biopsy published in 1966 stimulated
widespread interest.20 The researchers concluded that their 87%
rate of diagnostic accuracy was due to improvements in fluoro-
scopic monitoring, newly developed thin-walled needles, and
refinements in cytologic methods of diagnosis.
Now, more than half a century after the publication of the
Papanicolaou atlas, the study of cellular specimens from the
respiratory tract is established in major hospitals and clinics
throughout the world as a vital diagnostic procedure in the
evaluation of any patient with suspected primary or secondary
lung cancer, a prior established history of lung cancer, or any
suspected lung lesion in which morphologic confirmation is
indicated. The emergence of fine-needle aspiration (FNA) has
enhanced further the diagnostic usefulness of clinical cytology
in lung cancer diagnosis. The numerous and excellent reviews,
atlases, and monographs embracing all aspects of respiratory
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