PART TWO
Diagnostic Cytology
Table 13.25 Relationship between Sputum and Bronchial Material in Lung Cancer Diagnosis
Table 13.26 Prediction of Histologic Type of Primary Lung Cancer from Specimens of Sputum and Bronchial Material
Histologic
diagnosis
Cytologic diagnosis
Squamous cell
carcinoma
Adenocarcinoma
Large-cell
carcinoma
Small-cell
carcinoma
Adenosquamous
carcinoma
Unclassified
neoplasm
Squamous cell
carcinoma
152
6
37
4
0
2
Adenocarcinoma
4
61
24
0
1
2
Large-cell
carcinoma
22
9
28
1
6
0
Small-cell
carcinoma
0
1
2
64
0
1
Adenosquamous
carcinoma
0
0
1
0
3
0
Percent
152/178 (85%)
61/77 (79%)
28/92 (30%)
64/69 (93%)
3/10 (30%)
NA
correlations
Reproduced with permission from Johnston WW: Cytologic correlations. In: Dail DH, Hammar SP (eds)
Pulmonary Pathology.
New York: Springer-Verlag, 1987.
to regard the specimen obtained from bronchoscopy or FNA as
the one most likely to provide the cancer diagnosis.
correlation between Sputum and Bronchial
cytologic Specimens and the Histologic Specimen
In addition to the high levels of diagnostic accuracy achieved by
sputum and bronchial material in the detection of tumor cells,
the usefulness of these specimens in the prediction of histologic
type of lung cancer has been shown to be impressively high.
Ng and Horak, in their bronchial washing study, reported in
1983 that the accuracy of diagnosing tumor cell type was 96%
for squamous cell carcinoma, 86% for adenocarcinoma, 77%
for large-cell carcinoma, and less than 50% for BAC.523 In their
sputum study, also published in 1983, their levels of correlation
were as follows: squamous cell carcinoma 95.3%, adenocarci-
noma 87.8%, BAC 65.0%, large cell carcinoma 81.4%, small-cell
carcinoma 96.5%, and adenosquamous carcinoma 65.0%.524
Johnston and Frable,30 in their 1976 review of respiratory
cytology, compared the accuracy in cell typing of lung cancer
in two major academic hospitals. In the first institution, the lev-
els of predictive typing accuracy were squamous cell carcinoma
92%, adenocarcinoma 86%, small-cell undifferentiated carci-
noma 88%, and large-cell undifferentiated carcinoma 41%. In
the second institution, the levels were squamous cell carcinoma
75%, adenocarcinoma 83%, small-cell undifferentiated car-
cinoma 93%, adenosquamous carcinoma 75%, and large-cell
undifferentiated carcinoma 68%.
Suprun and associates, in a 1980 study, reported 75% of 232
malignant cytologic specimens as having been correctly typed.529
In a study published in 1982, Pilotti and associates reported an
overall typing accuracy with sputum of 77% in 229 cases.547 For
specific tumors, it was 94% for squamous cell carcinoma, 65%
for adenocarcinoma, 20% for large-cell carcinoma, and 81% for
small-cell carcinoma.525,526
A later study from our laboratory is summarized in Table
13.26. In this study, the cytologic and histologic diagnoses from
431 patients were compared. The highest level of cytologic pre-
dictive accuracy (93%) was achieved for small-cell undifferenti-
ated carcinoma. The cytologic presentation of this carcinoma is
one of the most characteristic and diagnostic of all the various
cancers encountered. Because of the high level of specificity of
this diagnosis, one is able to proceed with therapy with great
confidence without subjecting patients to the additional trauma
of biopsy or thoracotomy. Among the other cancers, the follow-
ing cytologic-histologic correlations were found: squamous cell
carcinoma 85%, adenocarcinoma 79%, large-cell undifferenti-
ated carcinoma 30%, and adenosquamous carcinoma 30%.
In reviewing the lower levels of cytologic-histologic correla-
tion obtained with the other varieties of primary lung cancer,
356
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