Fluorescence in situ hybridization testing algorithm improves lung cancer detection in bronchial brushing specimens.

Voss JS, Kipp BR, Halling KC, Henry MR, Jett JR, Clayton AC, Rickman OB
Am J Respir Crit Care Med. 2010 181 (5): 478-85

PMID: 20007925 · DOI:10.1164/rccm.200907-1121OC

RATIONALE - Bronchoscopically collected cytology specimens are commonly used to obtain a diagnosis of cancer in patients with pulmonary lesions. However, the sensitivity of cytology is suboptimal, especially for peripheral lesions less than 2 cm in diameter.

OBJECTIVES - We assessed the performance of a testing algorithm using cytology and fluorescence in situ hybridization (FISH) as part of clinical practice.

METHODS - Bronchial brushing specimens (n = 343) were obtained from patients undergoing bronchoscopy for indeterminate pulmonary lesions. Routine cytology was performed and specimens without a positive diagnosis (n = 294) were analyzed by FISH, using residual brushing material. Pathology-confirmed lung cancer or clinical/radiographic evidence of disease was considered diagnostic of malignancy.

MEASUREMENTS AND MAIN RESULTS - Routine cytology had a sensitivity and specificity of 41% (23 of 56) and 100% (45 of 45) for central lesions and 20% (26 of 133) and 100% (109 of 109) for peripheral nodules, respectively. FISH detected an additional 32% of lung cancers (18 central and 43 peripheral) not detectable by cytology alone, while producing false positive diagnoses in 22% (10 of 45) and 6% (6 of 109) benign central and peripheral lesions, respectively. In peripheral nodules, FISH detected (relative to routine cytology) an additional 44% (15 of 34) and 28% (25 of 91) of lung cancers less than 2 cm and 2 cm or more in size, respectively. A positive FISH result had a likelihood ratio of 1.45 and 5.87 for central and peripheral lesions and 3.44 and 15.38 for peripheral nodules less than 2 cm and 2 cm or more in size, respectively.

CONCLUSIONS - FISH testing significantly increases the detection of lung cancer over routine cytology alone. It is especially useful for peripheral nodules.

MeSH Terms (15)

Adult Aged Aged, 80 and over Algorithms Bronchi Bronchoscopy Chi-Square Distribution Female Humans In Situ Hybridization, Fluorescence Likelihood Functions Lung Neoplasms Male Middle Aged Sensitivity and Specificity

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