Background/introduction Current BTS guidelines suggest that when endobronchial tumour is seen optimal diagnostic sensitivity is achieved when at least five mucosal biopsies are supplemented with bronchial washings and brushings.
We review our bronchoscopy practice annually in line with current guidance, and strive to make continuous improvements. We have previously noted that bronchial brushings improve the diagnostic sensitivity for lung cancer when an endobronchial tumour is seen, but bronchial washing samples do not.
Aims To confirm that bronchial washings do not increase diagnostic sensitivity for lung cancer where endobronchial tumour is seen at flexible bronchoscopy.
Method We reviewed all flexible bronchoscopy procedures performed at our hospital during a two-year period (n = 365). We reviewed the Electronic Patient records for histology and cytology results in all cases where endobronchial tumour was visualised.
Results Mucosal biopsies and either bronchial brushings or bronchial washings or brushings and washings were performed in all cases where an endobronchial lesion was seen (n = 65). Washings were performed in addition to mucosal biopsies in 95% of cases, bronchial brushings however were sent in 78% of cases.
The diagnostic sensitivity for mucosal biopsies alone was 80% (n = 65), bronchial brushings in addition to mucosal biopsies improved diagnostic sensitivity to 86%. In the small number of cases (n = 4) mucosal biopsies were negative for malignancy but a malignant diagnosis made on bronchial brushings and washings, bronchial brushings were positive in all cases and whereas bronchial washings were positive in only 50%.
Conclusion Bronchial washings did not add any additional value to the diagnosis of lung cancer when endobronchial tumour was seen. We suggest that mucosal biopsies and brushings combined provide optimal diagnostic sensitivity in these cases. Omitting bronchial washing would produce both cost saving (in our Trust processing bronchial washings costs £76.50 per sample), and time efficiencies; bronchoscopists could then focus on obtaining multiple good quality mucosal biopsies, which are of paramount importance in molecular subtyping of lung cancers.