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. 1971 Nov;26(6):623–631. doi: 10.1136/thx.26.6.623

The diagnosis of primary lung cancer with special reference to sputum cytology

N C Oswald 1,2, K F W Hinson 1,2, G Canti 1,2, A B Miller 1,2
PMCID: PMC472376  PMID: 5144641

Abstract

Of 2,545 in-patients with primary lung cancer, pathological proof of the diagnosis was obtained by sputum cytology in 48%, by bronchoscopy in 32%, by biopsy from miscellaneous sites in 12%, and at thoracotomy or necropsy only in 19%. The diagnosis was made solely on clinical and radiological evidence in 8%.

One or more satisfactory specimens of sputum from 2,035 patients gave a positivity rate of 59%. When three specimens of sputum were tested the positivity rate was 69% and when four or more were tested, 85%. The maximum false positivity rate was 0·7%. Agreement between the types of malignant cells found in the sputum and in resected or necropsy specimens occurred in 84%. The pathological diagnosis was based solely on sputum cytology in 40% of the patients in whom malignant cells were found in the sputum.

The total work of the sputum laboratories was analysed for one year (1967); sputum was examined from 1,598 patients, of whom 266 (17%) had positive results.

Of 1,518 patients who had a bronchoscopy, the positivity rate was 53%, and of 524 patients with biopsies from miscellaneous sites the rate was 64%.

Sputum cytology, as practised at present, is a very valuable method of diagnosis, but its demands on time and expertise make it unsuitable for general application outside large medical centres.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ATTAR S., NAIB Z. M., COWLEY R. A. Exfoliative cytology in solitary peripheral lesions of the lungs. J Thorac Cardiovasc Surg. 1961 Aug;42:168–173. [PubMed] [Google Scholar]
  2. Adamson J. S., Jr, Bates J. H. Percutaneous needle biopsy of the lung. Arch Intern Med. 1967 Feb;119(2):164–169. [PubMed] [Google Scholar]
  3. BODDINGTON M. M., SPRIGGS A. I. CYTOLOGICAL DIAGNOSIS OF CANCER: ITS USES AND LIMITATIONS. Br Med J. 1965 Jun 12;1(5449):1523–1529. doi: 10.1136/bmj.1.5449.1523. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Blair C. R., Hughes J. H. Scalene node biopsy: a re-evaluation. J Thorac Cardiovasc Surg. 1966 Oct;52(4):595–598. [PubMed] [Google Scholar]
  5. Brantigan O. C., Moszkowski E. Bilateral biopsy of non-palpable cervical lymph nodes. Diagnosis and prognosis in carcinoma of the lung. Dis Chest. 1966 Nov;50(5):464–469. doi: 10.1378/chest.50.5.464. [DOI] [PubMed] [Google Scholar]
  6. CUNNINGHAM G. J., WINSTANLEY D. P. Hyperplasia and metaplasia in the bronchial epithelium. Ann R Coll Surg Engl. 1959 May;24(5):323–330. [PMC free article] [PubMed] [Google Scholar]
  7. DONOHOE R. F., KATZ S., MATTHEWS M. J. Pleural biopsy as an aid in the etiologic diagnosis of pleural effusion: review of the literature and report of 132 biopsies. Ann Intern Med. 1958 Feb;48(2):344–362. doi: 10.7326/0003-4819-48-2-344. [DOI] [PubMed] [Google Scholar]
  8. Davies D. F. A review of detection methods for the early diagnosis of lung cancer. J Chronic Dis. 1966 Aug;19(8):819–845. doi: 10.1016/0021-9681(66)90002-6. [DOI] [PubMed] [Google Scholar]
  9. Delarue N. C., Strasberg S. M. The rationale of intensive preoperative investigation in bronchogenic carcinoma. J Thorac Cardiovasc Surg. 1966 Mar;51(3):391–411. [PubMed] [Google Scholar]
  10. Duguid H. L., Huish D. W. Clinical Evaluation of Cytodiagnosis in Bronchial Carcinoma. Br Med J. 1963 Aug 3;2(5352):287–291. doi: 10.1136/bmj.2.5352.287. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. GRUNZE H. A critical review and evaluation of cytodiagnosis in chest diseases. Acta Cytol. 1960;4:175–198. [PubMed] [Google Scholar]
  12. HATTORI S., MATSUDA M., SUGIYAMA T., MATSUDA H. CYTOLOGIC DIAGNOSIS OF EARLY LUNG CANCER: BRUSHING METHOD UNDER X-RAY TELEVISION FLUOROSCOPY. Dis Chest. 1964 Feb;45:129–142. doi: 10.1378/chest.45.2.129. [DOI] [PubMed] [Google Scholar]
  13. HINSON K. F., KUPER S. W. THE DIAGNOSIS OF LUNG CANCER BY EXAMINATION OF SPUTUM. Thorax. 1963 Dec;18:350–353. doi: 10.1136/thx.18.4.350. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. JENNINGS R. C., SHAW K. M. The value of cytological examination of the sputum in the diagnosis of carcinoma of the bronchus. Thorax. 1953 Dec;8(4):288–294. doi: 10.1136/thx.8.4.288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. KLINGENBERG I. HISTOPATHOLOGIC FINDINGS IN THE PRESCALENE TISSUE FROM 1,000 POST-MORTEM CASES. Acta Chir Scand. 1964 Jan-Feb;127:57–66. [PubMed] [Google Scholar]
  16. LERNER M. A., ROSBASH H., FRANK H. A., FLEISCHNER F. G. Radiologic localization and management of cytologically discovered bronchial carcinoma. N Engl J Med. 1961 Mar 9;264:480–485. doi: 10.1056/NEJM196103092641003. [DOI] [PubMed] [Google Scholar]
  17. MELAMED M. R., KOSS L. G., CLIFFTON E. E. ROENTGENOLOGICALLY OCCULT LUNG CANCER DIAGNOSED BY CYTOLOGY: REPORT OF 12 CASES. Cancer. 1963 Dec;16:1537–1551. doi: 10.1002/1097-0142(196312)16:12<1537::aid-cncr2820161205>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  18. MEYER J. A., UMIKER W. O. A review of problems relating to the "diagnostic triad" in lung cancer. Bronchoscopy, scalene lymph node biopsy, and cytopathology of bronchial secretions. Surg Clin North Am. 1961 Oct;41:1233–1244. doi: 10.1016/s0039-6109(16)36487-8. [DOI] [PubMed] [Google Scholar]
  19. PAPANICOLAOU G. N., KOPROWSKA I. Carcinoma in situ of the right lower bronchus; a case report. Cancer. 1951 Jan;4(1):141–146. doi: 10.1002/1097-0142(195101)4:1<141::aid-cncr2820040115>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  20. PHILPS F. R. The identification of carcinoma cells in the sputum. Br J Cancer. 1954 Mar;8(1):67–96. doi: 10.1038/bjc.1954.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Papanicolaou G. N. A NEW PROCEDURE FOR STAINING VAGINAL SMEARS. Science. 1942 Apr 24;95(2469):438–439. doi: 10.1126/science.95.2469.438. [DOI] [PubMed] [Google Scholar]
  22. RAEBURN C., SPENCER H. A study of the origin and development of lung cancer. Thorax. 1953 Mar;8(1):1–10. doi: 10.1136/thx.8.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. RUSSELL W. O., NEIDHARDT H. W., MOUNTAIN C. F., GRIFFITH K. M., CHANG J. P. Cytodiagnosis of lung cancer: a report of four-year laboratory, clinical study with a review of the literature on lung cancer and pulmonary cytology. Acta Cytol. 1963 Jan-Feb;7:1–44. [PubMed] [Google Scholar]
  24. Steel S. J., Winstanley D. P. Trephine biopsy of the lung and pleura. Thorax. 1969 Sep;24(5):576–584. doi: 10.1136/thx.24.5.576. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. UMIKER W., STOREY C. Bronchogenic carcinoma in situ; report of a case with positive biopsy, cytological examination, and lobectomy. Cancer. 1952 Mar;5(2):369–374. doi: 10.1002/1097-0142(195203)5:2<369::aid-cncr2820050227>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  26. UMIKER W. The current role of exfoliative cytopathology in the routine diagnosis of bronchogenic carcinoma. A five-year study of 152 consecutive, unselected cases. Dis Chest. 1961 Aug;40:154–159. doi: 10.1378/chest.40.2.154. [DOI] [PubMed] [Google Scholar]
  27. WIERMAN W. H., McDONALD J. R., CLAGETT O. T. Occult carcinoma of the major bronchi. Surgery. 1954 Mar;35(3):335–345. [PubMed] [Google Scholar]
  28. WOOLNER L. B., ANDERSEN H. A., BERNATZ P. E. "Occult" carcinoma of the bronchus: a study of 15 cases of in situ or early invasive bronchogenic carcinoma. Dis Chest. 1960 Mar;37:278–288. doi: 10.1378/chest.37.3.278. [DOI] [PubMed] [Google Scholar]

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