The diagnosis of small peripheral lung cancer is difficult to achieve by non-invasive methods. We hypothesized that in these patients induced sputum might ncrease the diagnostic yield over spontaneous sputum, representing a good diagnostic alternative in selected patients. We prospectively evaluated 60 patients with peripheral lung lesions and normal bronchoscopic evaluation. Six samples of sputum (three spontaneous and three induced with nebulization of hypertonic saline) before bronchoscopy and six samples of sputum after bronchoscopy (three spontaneous and three induced) were obtained in each subject. Forty-two out of the 60 patients included were finally diagnosed with lung cancer. Eighteen patients were diagnosed with different benign conditions of the lung. Overall, malignant cells in sputum were observed in 21 patients and in all but one, the final diagnosis of lung cancer was achieved. Only one patient with a pseudoinflammatory tumour of the lung had a false-positive result in one spontaneous sputum sample. The diagnosis of lung cancer was obtained in 18 patients with the induced sputum (43%) and in 14 patients with spontaneous sputum (31%) (P=NS). Samples of induced sputum were more adequate for cytological analysis than samples of spontaneous sputum (P < 0.001). Of 13 patients with peripheral lung neoplasms of 2 cm or less in diameter, five were diagnosed using induced sputum (38%) and only one using spontaneous sputum (8%) (P<0.05). In conclusion, induced sputum is a valuable technique for the diagnosis of peripheral lung cancer. Induced sputum gives better quality specimens and better diagnostic yield in small lesions than the spontaneous sputum and may be indicated in selected patients with disseminated disease, inoperability or severe co-morbities.

Cytomorphologic changes in split-course radiation-treated bronchogenic carcinomas.Diagn Cytopathol. 1988 Mar;4(1):9-13.

The cellular changes produced by radiation therapy were studied in cytologic specimens from seven patients with bronchogenic carcinoma: squamous-cell carcinoma (four patients), adenocarcinoma (two patients), and small-cell undifferentiated carcinoma (one patient). Cytologic samples were obtained from sputum and bronchoscopic examination in patients before and after they received a course of radiation. The cells were studied by light microscopy. An increase in the percentage of columnar cells was detected in five of seven patients independent of the latency of cytologic sampling posttherapy. The percentage of macrophages was unchanged in patients sampled at 15, 18, and 24 mo after the last radiation dose; leukocytes were decreased in relative frequency in the majority of patients studied. Following irradiation, moderately atypical and severely atypical metaplastic cells were increased in relative frequency (48% versus 15% and 19% versus 3%, respectively) and malignant cells were decreased (40% versus 22%) or absent in all patients, irrespective of the type of carcinoma. Nuclear vacuolation, nuclear enlargement, loss of chromatin texture, and rupture of the chromatinic rim were seen in atypical and cancer cells. Infiltration of cancer cells by leukocytes was observed in two of four patients with squamous-cell carcinoma. In all treated patients, morphologic observations indicated that irradiation produces similar damage to "normal" bronchial epithelial cells although such changes are less apparent at longer time intervals following therapy.

Cytologic features of peripheral squamous cell carcinoma of the lung.Acta Cytol. 1995 Jan-Feb;39(1):61-8.

Cytologic features of 32 peripheral squamous cell carcinomas of the lung were reviewed. Fine needle aspiration biopsy and curettage showed most of the tumor cells to be arranged in irregular cell fragments consisting of relatively small cells with scanty cytoplasm. They possessed round to oval nuclei with coarsely granular chromatin, and some had large, prominent nucleoli. Keratinization was usually observed in small numbers of scattered cells, and a nuclear streaming arrangement was noted in some areas. When both keratinization and streaming arrangements were absent, correct subtyping was impossible (12 cases). These cytologic features were different from those of 31 hilar squamous cell carcinomas studied as controls; there many carcinoma cells showed keratinization, and small carcinoma cells were infrequent. However, in all cases, sputum cytology was correctly interpreted because squamous differentiation was easily recognized.

Value of sputum cytology in the diagnosis and typing of bronchogenic carcinomas, excluding adenocarcinomas.Acta Cytol. 1982 Sep-Oct;26(5):645-8.

In 320 selected cases with a cytologic diagnosis of bronchogenic carcinoma, the cytologic typing of the tumor was correlated with histology to determine the rate of correct diagnoses. Although 205 cases (64.1%) showed a correct correlation using consecutive sputum cytology, in 115 "inconclusive" cases (35.9%) it was necessary to study further cytologic material after bronchoscopy in order to achieve a 90.3% overall correlation. Although an exact cytohistologic correlation was possible in all cases of epidermoid carcinomas and 92.1% of small-cell carcinomas, only 55.3% of undifferentiated carcinomas could be correctly correlated. In 44.7% of the latter type, subsequent tissue examination showed a different type of primary bronchogenic carcinoma; malignant cells were not missed cytologically in any of these cases. These results suggest that initially sputum cytology should be employed in all cases whereas further cytologic examination of material after bronchoscopy is essential in inconclusive cases to correctly diagnose and type bronchogenic carcinomas in a higher percentage of cases.

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