Correlation Of Bronchial Brushing Cytology With Bronchial Biopsy In Diagnosis Of Lung Cancer. J Pharm Biomed Sci 2014; 04(06):

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1 JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES Pancharia A, Yadav V, Taneja C, Chauhan S, Chauhan R, Gauttam V., A Study Of Correlation Of Bronchial Brushing Cytology With Bronchial Biopsy In Diagnosis Of Lung Cancer. J Pharm Biomed Sci 2014; 04(06): The online version of this article, along with updated information and services, is located on the World Wide Web at: Journal of Pharmaceutical and Biomedical Sciences (J Pharm Biomed Sci.), Member journal. Committee of Publication ethics (COPE) and Journal donation project (JDP).

2 Research Article A Study Of Correlation Of Bronchial Brushing Cytology With Bronchial Biopsy In Diagnosis Of Lung Cancer Aruna Pancharia 1,*, Vandana Yadav 2, Charu Taneja 3,Sunanda Chauhan 4, Rupa Chauhan 5,Vinod Gauttam 6 Affiliation:- 1 M.D. Scholar, Department of Pathology Geetanjali Medical College & Hospital, Udaipur (Raj.),India 2 M.D. Scholar,Department of Pathology M. G. Institute of Medical Sciences Sewagram Wardha Maharashtra,India 3 Assistant Prof. Department of Anatomy Geetanjali Medical College & Hospital, Udaipur (Raj.),India 4 Assistant Prof. Department of Pathology Geetanjali 5 Medical College & Hospital, Udaipur (Raj.),India DCP, Department of Pathology Geetanjali Medical College & Hospital, Udaipur (Raj.),India 6 Medical officer at Savina Khera PHC Udaipur,India The name of the department(s) and institution(s) to which the work should be attributed: 1.Department of Pathology, Geetanjali Medical College & Hospital, Udaipur (Raj.),India 2 Department of Pathology M. G. Institute of Medical Sciences Sewagram Wardha Maharashtra,India 3 Department of Anatomy Geetanjali Medical College & Hospital, Udaipur (Raj.), India 4 Medical College & Hospital, Udaipur (Raj.),India Authors contributions All of the authors drafted, revised the article and approved the final version. *To whom it corresponds:- Dr. Aruna Pancharia. Department of Pathology Geetanjali Medical College & Hospital, Udaipur (Raj.), India E mail Address: bsntshrm83@gmail.com Abstract Introduction: Lung cancer is one of the commonest malignant neoplasm all over the world. lt accounts for more cancer deaths in both men and women worldwide than any other cancer and is increasingly being recognised in India 1. Lung cancer is one of the leading causes of death in western countries and In India also, lung cancer is most common in males in all urban registries. Fiberoptic bronchoscopy has an excellent result in diagnosis of lung cancer when combined with brushing cytology & biopsy 2. Method: A total of 58 cancer positive biopsies were included in this study on whom bronchoscopy was performed specimens were collected over the period of 2 year. Bronchial brushing, biopsy specimens were collected & processed accordingly. Results: Out of 58 malignant cases, the most common was the squamous cell carcinoma (58.62%), followed by adenocarcinoma (18.96%), small cell carcinoma (12.06%), miscellaneous (8.62%) & large cell carcinoma (1.72%). There were 53 male & 5 female with male to female ratio The average age of the cases ranged from 21 years to 86 years, the average age being 59 years. Thus, cytohistological correlation was done in 58 malignant cases. Conclusion: Bronchial biopsy has better detection rate than brushing cytology in this study. Bronchial brushing cytology is an inexpensive, less invasive, quick and effective diagnostic tool in detection of lung cancer. However combination of these modalities gives higher detection rate for bronchoscopically visible tumor. Therefore, bronchial brush cytology should be performed whenever possible in all suspected cases of lung cancer. Keywords: Bronchial brushing cytology; bronchial biopsy, lung cancer. Source of support: None Competing interest / Conflict of interest The author(s) have no competing interests for financial support, publication of this research, patents and royalties through this collaborative research. All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript. 492

3 Article citation: Pancharia A, Yadav V, Taneja C, Chauhan S, Chauhan R, Gauttam V. A study of correlation of bronchial brushing cytology with bronchial biopsy in diagnosis of lung cancer. J Pharm Biomed Sci 2014;04(06): Available at INTRODUCTION Cytological method in diagnosis of cancer of respiratory tract has been acclaimed as one of best application. With the use of flexible fiber optic bronchoscope, respiratory cytology become efficient enough in taking sample of bronchial washing, bronchial brushing, bronchoalveolar lavage and transbronchial needle aspiration, and yielding significant amount of material 3. Lung cancer is one of the commonest malignant neoplasm all over the world. lt accounts for more cancer deaths in both men and women worldwide than any other cancer and is increasingly being recognized in India. Lung cancer is one of the leading causes of death in western countries and In India also, lung cancer is most common in males in all urban registries. The increasing incidence could be due to increase in smoking habit, change in life styles of the people, increased environmental pollution, and at the same time, due to availability of different modern diagnostic modalities to detect lung cancer1 Fiberoptic bronchoscopy has an excellent result in diagnosis of lung cancer when combined with brushing cytology & biopsy. Bronchoscopy, followed by brushing and biopsy, in clinically and radiologically suspected cases, is the main diagnostic procedure in our contest. Brushing cytology is considered as an effective tool to diagnose this condition as it covers wider area (2 cm) compared to less than 5 mm by forceps & it is easy to obtain brushing cytology sample 2.When biopsy is difficult in certain anatomical location of the lesions. This prospective study was conducted at Geetanjali Medical College & Hospital, Udaipur over the period of two year with the aim to correlate brushing cytology with biopsy in diagnosis lung cancer. Figure 1.Adenocarcinoma Cytology METHOD This prospective study was conducted at Geetanjali Medical College & Hospital, Udaipur over the period of Two year. All the cases, clinically & radiologically suspected of lung cancer, undergoing brush cytology and bronchial biopsy done, were included in this study. Bronchoscopy was performed with flexible bronchoscope in endoscopy department. Patients with normal bronchoscopic findings were excluded from study at this stage. Brushing cytology specimens were collected. The brush along with adhered cells was smeared on glass slides & fixed immediately in 95% propanolol and stained with Papanicolaou stain after fixation. Bronchial biopsy specimens were collected, biopsy was taken by different method like bronchial biopsy, CT guided biopsy, and transthorasic biopsy. The specimens were fixed with 10% formal saline for 1 day & processed in automated tissue processor and sections were prepared and stained with haematoxylin & eosin stain. RESULTS Out of 58 malignant cases, The most common was the squamous cell carcinoma (Fig.3) (58.62%), followed by adenocarcinoma (Fig.2) (18.96%), small cell carcinoma (Fig.6) (12.06%), miscellaneous (8.62%) & large cell carcinoma (1.72%) showing in (Table 2). specimens were collected over the period of 2 year. cytohistological Figure 2.Adenocarcinoma Biopsy 493

4 correlation was done in 58 malignant cases. Different types of carcinomas diagnosed by brush cytology are tabulated (Table 1). Among them, squamous cell carcinoma comprised (fig.4) 48.27%, adenocarcinoma (Fig.1) 8.62%, & small cell carcinoma (Fig.5) 6.89%. Large cell carcinoma (1.72%). Figure 3.Squamous cellcarcinoma Biopsy. Figure 4.Squamous cell carcinoma cytology. Figure 5.Small Cell Carcinoma- Cytology. CORRELATION OF BRONCHIAL BRUSHING CYTOLOGY AND BIOPSY: Both bronchial biopsy and brushing cytology were positive for malignancy in 38 cases. Out of 34 cases, 28 cases were of squamous cell carcinoma, which were detected by brushing cytology & were well correlated. 5 out 11of adenocarcinoma, 4 out of 7 of small cell carcinoma, which were detected by brushing cytology, one out of one of large cell carcinoma were detected by brushing cytology. No miscellaneous case could be detected by brush cytology and 20 cases out of 58 were given negative for malignancy which was proved to be malignant by biopsy. Figure 6.Small Cell Carcinoma- Biopsy. DISCUSSION Bronchoscopy is an important diagnostic modality in the early diagnosis of lung carcinoma. In addition to direct visualization of the lesion, brushing and tissue for histopathological examination can be obtained. Thus bronchial brushing has firmly established its role in the early diagnosis of lung carcinoma because it is safe, rapid and cost effective and importantly gives a higher rate of sensitivity and accuracy. However combination of these modalities gives higher detection rate for bronchoscopically visible tumor. Therefore, bronchial brush cytology should be performed whenever possible in all suspected cases of lung cancer. 494

5 Timely detection of the disease plays a pivotal role in the management & for the long term survival of the patients. Bronchial brushing cytology is considered as an effective diagnostic tool for this condition. Though it is inferior to bronchial biopsy in histological typing, it is quite safe, less invasive, economical & provide quick results as compared to bronchial biopsy 2,5,6. It is highly sensitive & specific procedure as specimen is directly obtained from the lesion without contamination of saliva or nasopharyngeal secretion 7. In this study, the most common tumor was squamous cell carcinoma 58.89%, followed by adenocarcinoma 18.96%, small cell carcinoma 12.06%, large cell carcinoma 1.72%. In 38 cases, brushing cytology were well correlated with biopsy which was taken as a gold standard. There were no cytologically false positive cases. This tallies with the study conducted by eva piya et al. according to which squamous cell carcinoma was the most common one comprising 64.2%, followed by adenocarcinoma 18.8%, small cell carcinoma 7%, large cell carcinoma 1% 3. Sayami G et al, according to which squamous cell carcinoma was the most common one comprising 64.3%, followed by adenocarcinoma 17.4%, small cell carcinoma 15.4%, large cell carcinoma 2% carcinoid tumor 0.2%, bronchioalveolar carcinoma 0.2% and mucoepidermoid carcinoma 0.2%8. Brushing had a good detection rate for all the tumor types in this study. It detected 82.35% of squamous cell carcinoma, % of adenocarcinoma, and 57.14% of small cell carcinoma.100% of large cell carcinoma. While biopsy had better detection rate in all cases. In many studies biopsy had a better detection rate. In one study done in Nepal Medical College, lung cancer detection rate of bronchial biopsy was 92.2%, while brushing could detect only 65.2% of the cases 9. Similarly another study conducted by KA Gaber et al., biopsy had a better detection rate than brushing cytology ie. 79.4% versus 74.5% 10. However in many studies brushing had a better detection for the tumor types according to some study M Matsuda et al. observed that bronchial brushing had better detection rate (90.3%) than biopsy(64.8%).combination of both modalities yielded highest incidence of positive diagnosis((93.7%). It is because brushing covers the wide area than biopsy and a significant amount of material can be obtained 11. According to Ashok K et al, also brushing had better detection rate than biopsy 72% versus 69% 12. Table 1.Types of Carcinomas diagnosed by bronchial brush cytology. Histological types of carcinomas Number Percentage (%) Squamous cell carcinoma Adenocarcinoma Small cell carcinoma Large cell carcinoma Miscellaneous 0 0 Negative for malignancy Total Table 2. Types of carcinomas diagnosed by bronchial biopsy. Histological types of carcinomas Number Percentage (%) Squamous cell carcinoma Adenocarcinoma Small cell carcinoma Large cell carcinoma Miscellaneous Negative for malignancy 0 0 Total

6 Table 3. Comparison between brushing & biopsy. Biopsy Positive Biopsy Negative Total Brushing Positive Brushing Negative Total CONCLUSION Lung cancer is one of the major causes of morbidity & mortality in developing countries. Bronchial brushing cytology is an inexpensive, less invasive, quick and effective diagnostic tool in detection of lung cancer and it can diagnose lung cancers where bronchoscopic biopsy is technically not feasible or not interpretable. It is highly sensitive procedure. It has insignificant false positive or negative results, so at advanced stage it can be the only important & time saving preoperative diagnostic tool in our contest. Though biopsy had better detection rate than brushing (because here in this study different biopsy method are available for comparison, so that several technical difficulties e.g. stenosis, bleeding, peripheral location of tumor are overwhelmed and biopsy give better result). However combination of these modalities gives higher detection rate for bronchoscopically visible tumor. REFERENCES 1.Sweta Kasana, Comparative study of bronchial washings, bronchial brushings and bronchial biopsies in diagnosing centrally located carcinoma lung, M.D. thesis in Sawai Mansingh Medical College Jaipur, Rajasthan Eva Piya, Geeta Sayami, Brajendra Srivastava. Correlation of bronchial brushing cytology with bronchial biopsy in diagnosis of lung cancer. Medical Journal of Shree Birendra Hospital 2011;10(2): DS Gaur, NC Thapliyal, S Kishore, VP Pathak. Efficacy of broncho-alveolar lavage and bronchial brush cytology in diagnosing lung cancer. Journal of cytology.2007; 24:(2): Johnston WW, Elson CE. Respiratory tract.in:bibbo M, Editor, Comprehensive Cytopathology. 2 nd ed. Philadelphia: WB Saunder company ;1997.P Gaber KA. Cytologic examinati on of whole endobronchial brush in bronchoscopic diagnosis of lung cancer. Respiratory Medicine. 2002;96(4): Thomas LP. Sputum cytology for early diagnosis of lung cancer.current Opinion in Pulmonary Medicine. 2003;19(40): Kawaraya M, Gemba K, Ueoka H, Nishii K, Kodani T. Evaluation of various cytological examinati ona by bronchoscopy in diagnosis of peripheral lung cancer. British Journal of Cancer.2003; 89: Sayami G. Sayami P. Bronchial brushing cytology in suspected lung cancer. JNMA.1993; 31: Ramesh C,Prakrita Bhushan P, Devkota Kc. Clinical & Histocytological Profi Le Of 200 Consecuti Ve Video Bronchoscopies. Nepal Medical College Journal 2002;4(2): Saita S. Bronchial Brushing Biopsy: A Comparative Evaluation in Diagnosing Visible Lesions.Eur.J.Cardithoracic Surg.1990; 4(5): Minoru Matsuda, Takeshi Horai, Shinichiro Nakamura, Bronchial Brushing And Bronchial Biopsy: Comparison Of Diagnostic Accuracy And Cell Typing Reliability In Lung Cancer Thorax 1986;41: Ashok K, Tanwani, H Anwar Ul. Correlati On Of Bronchial Brushing and Biopsy in Lung Lesions. Pakistan J Med Res.2000; 39(3)1: Copyright 2014 Pancharia A, Yadav V, Taneja C, Chauhan S, Chauhan R, Gauttam V. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 496