The early diagnosis of primary lung cancer by cytologic methods.

Abstract

Six thousand two hundred and eighty-one specimens of sputum or bronchial secretions from 2,066 patients were studied by cytologic techniques. Two hundred and forty-one patients had bronchogenic cancer diagnosed by pathologic studies. A positive cytologic diagnosis was made in 55 per cent of these 241 patients. When five or more sputum specimens were examined, the accuracy rose to 90 per cent. The clinical applications of cytologic diagnostic techniques are discussed: Cytology is of value to the thoracic surgeon in establishing a reliable preoperative morphologic diagnosis of lung cancer. A positive cytologic diagnosis may be made in many cases where the lesions are located in the periphery of the lung or upper lobe bronchi where bronchoscopic examinations are of limited value. Difficult diagnostic problems may be solved when a definite morphologic diagnosis of cancer is made by positive cytologic studies. In patients with coexistent pulmonary tuberculosis and bronchogenic carcinoma, cytologic studies may clarify a confusing clinical picture. Cytologic studies of sputum may be utilized as routine screening procedures on patients with minimal or no pulmonary symptoms. In our series of pathologically proved bronchogenic cancer, a positive cytologic diagnosis was made oftener and sooner than other morphologic diagnoses. In 47 per cent of these cases cytology was the first diagnostic procedure to establish a morphologic diagnosis. Earlier diagnoses will be made when cytologic techniques are applied immediately after cancer is suspected. Earlier diagnoses will be made when this diagnostic method is utilized on patients with equivocal lung lesions detected by routine roentgen surveys. Earlier diagnoses will be made when patients with cough and sputum—whether cancer is suspected or not—are routinely studied by cytologic techniques.