Diagnosis of Bronchogenic Carcinoma by Cytologic Methods

Abstract

Attention has been focused recently upon the application of cytologic technics to the diagnosis of primary carcinoma of the lung. Experience with 100 cases of proved bronchogenic carcinoma has indicated that this technic has diagnostic value. The need for additional diagnostic aids in this disease has been emphasized in reported series (1, 2, 3, 4, 5) in which as high as 50 per cent of the cases were not recognized prior to autopsy. As early as 1887 Hampeln was able to diagnose carcinoma of the lung by examination of unstained microscopic particles of expectorated malignant tissue. Other early workers also reported the diagnosis of cancer of the lung by finding bizarre cells in sputum examined by such simple methods. More recent investigators have blocked and sectioned sputum, using ordinary histologic technics, and some have reported good results (6, 7). The development of wet-film technics has simplified the cytologic study of sputum and bronchial secretions and has led to more widespread use of this diagnostic procedure. In 1935 Dudgeon and Wrigley (8) described their wet-film technic for the diagnosis of malignant disease of the lung. In 1944 Wandall (9) of Denmark reported the use of this method with excellent results. He found malignant cells in 84 of 100 cases of proved bronchogenic carcinoma. The work of Papanicolaou and Traut (10), in 1943, on the diagnosis of uterine cancer by vaginal smears stimulated the application of the Papanicolaou technic to material exfoliated from other accessible tracts (11). Herbut and Clerf (12) in 1946 presented their experiences with this technic applied to bronchial secretions. These workers were able to make an accurate diagnosis in 47 of 57 cases (82 per cent) of carcinoma of the lung. Reports of successful application of the Papanicolaou method to sputum and bronchial secretions continue to appear in the current literature (13, 14, 15). For the past two years we have been studying and evaluating the Papanicolaou method as applied to sputum and bronchial secretions (16, 17). This paper deals briefly with this study, the methods used and results obtained, and presents illustrative case histories. The material was obtained from university hospitals, general private hospitals, tuberculosis sanitariums, and private physicians. The patients were not in special cancer hospitals but either were suspected of having carcinoma of the lung or had an undiagnosed chest disease. Many specimens were received by mail from institutions and communities where adequate diagnostic facilities were not available. Sputum was obtained by deep coughing and bronchial secretions by aspiration from suspected areas of the bronchial tree. The preparation of smears for examination has been described in detail in a previous publication (17). After the smears were stained, every field on every slide was carefully screened by trained technicians. Unusual cells were marked and examined by physicians experienced in cytologic diagnosis.