Image1: Sputum- Group of adenocarcinoma cells. Mucinous vacuoles are present.

Image2: Bronchial washing- Group of pleomorphic malignant cells. The cytoplasmic and nuclear features are those of an adenocarcinoma.

1. The tumour is becoming more common especially in women.

2. Often peripheral and less prone to exfoliation than squamous tumors.

3. Presents mainly in cell groups and clusters, also some cell dissociation.

4. Cyanophilic delicate cytoplasm, which may be vacuolated.

5. Enlarged vesicular nuclei, prominent nuclear membranes and nucleoli.

6. Necrosis is uncommon in exfoliative cytology samples.

7. Subtyping of adenocarcinoma is difficult in cytological material.

Results of sputum cytology in bronchogenic carcinoma--a correlation with patient survival.Gan No Rinsho. 1984 Aug;30(10):1235-40.

In a study of 65 of patients with bronchogenic carcinoma who had thoracotomy over a 5-year period, cytodiagnosis by 3-day consecutive sputum cytology was reported positive for malignant cells in 55.4%. Data analysis revealed that the overall cytodiagnosis correlated with clinical stage, tumor size, site of origin, topography and histologic types. From the histologic standpoint, the site of origin was significantly related to the positive cytology in patients with squamous cell carcinoma among factors influencing the results of sputum cytology. On the other hand, there was a correlation of tumor size and the positive cytology in patients with adenocarcinoma. In addition, poor prognosis related to the positive cytology in adenocarcinoma cases in terms of the relationship between the results through sputum examination and survival. The authors emphasized that sputum cytology has proven to be a valuable factor for determining prognosis, especially in patients with adenocarcinoma

Factors significant in the diagnostic accuracy of lung cytology in bronchial washing and sputum samples. I. Bronchial washings.Acta Cytol. 1983 Jul-Aug;27(4):391-6

Some factors influencing the diagnostic accuracy for primary lung cancer in bronchial washings were studied in 276 consecutive cases seen between 1959 and 1974. Diagnostic accuracy increased during the years under study; the reasons included increasing expertise of the laboratory staff, better documentation of cytologic criteria and improved collection techniques. The overall accuracy was 74%. Detection of malignant cells was highest for squamous-cell and adenosquamous carcinomas (81%), small-cell carcinoma, adenocarcinoma and large-cell carcinoma (70%) and lowest for bronchioloalveolar-cell carcinoma (47%). Accuracy was 84% for central tumors as compared to 30% for peripheral lesions. Tumors of less than 2 cm in diameter yielded very poor results (15%) while those greater than 2 cm yielded 82% accuracy. The specificity of diagnosis of cell type in those specimens with malignant cells was over 93% for squamous-cell carcinoma, small-cell carcinoma and adenocarcinoma, 77% for large-cell carcinoma and below 50% for adenosquamous carcinoma, bronchioloalveolar carcinoma and the uncommon tumors. Two bronchial washings per case gave an appreciably better result (92%) than one per case (68%). The percentage of unsatisfactory specimens from those with cancer was 13.5 and from a control group was 29.9. Reasons for unsatisfactory specimens included limited cellular material, excessive blood and/or leukocytes and drying artifacts.

Lung cancer cell type as a determinant of bronchoscopy yield.Chest. 1983 Oct;84(4):428-30.

The accuracy of diagnosis of lung cancer obtained by fiberoptic bronchoscopy utilizing sputum cytology and bronchial biopsy depends on the size, location, and number of biopsy samples taken from the tumor. We have found that the accuracy of diagnosis also depends upon the histologic type of cancer. Fiberoptic bronchoscopy (brushings, washing, and biopsies) was performed and sputum cytology and bronchial tissue was obtained from 51 patients with histologically-proven lung cancer. The bronchial biopsy was more sensitive than the bronchial washing and brushing techniques in detecting primary bronchogenic and metastatic carcinoma. It was positive in ten of ten patients with small cell carcinoma, 12 out of 20 cases of squamous cell carcinoma, three of four cases of adenocarcinoma, and three of four patients with large cell cancer. The bronchial biopsy yield was influenced by the histologic cell type with the highest diagnostic yield being found with small cell carcinoma

Effect of methods of sample taking on the cytologic diagnosis of lung tumors. Acta Cytol. 1978 Sep-Oct;22(5):425-30

By the evaluation of unselected cytologic specimens taken by different methods, the possible effect of sampling on the cytologic diagnosis was analyzed. A statistically significant tendency was established for certain tumors to be better diagnosed by certain methods of sampling. In order of the increasing radicality of the method, the following significant coincidences were found and discussed: Sputum for the diagnosis of bronchialalveolar cell carcinoma and epidermoid carcinoma (cornified cells); Bronchial washing for oatcell (undifferentiated) carcinoma and epidermoid carcinoma (moderately cornified cells); Bronchial brushing for epidermoid carcinoma (not cornified cells) and large cell (undifferentiated) carcinoma; Transthoracal needle aspiration for polymorphic carcinoma and metastasis; and Pleural effusion for the diagnosis of metastasis, bronchogenic adenocarcinoma and mesothelioma. If the clinical features indicate a certain tumor type, the data give evidence that it is advantageous to adjust the method of sample taking to the expected tumor type as far as possible. In the case of necessary re-examinations, transthoracic needle aspiration and bronchial brushing should especially be used, in addition to the self-evident examination of material produced spontaneously, i.e., sputum and pleural effusion, because of the relatively high expected value of these methods for positive diagnoses in re-examinations.

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