ORIGINAL ARTICLE Bronchoscopic diagnosis of endoscopically visible lung malignancies: should cytological examinations be carried out routinely? C. C. Dobler and A. B. H. Crawford Department of Respiratory Medicine, Liverpool Hospital, Sydney, New South Wales, Australia Key words bronchoscopy, lung neoplasm, diagnosis, cytology, biopsy. Correspondence Claudia C. Dobler, Department of Respiratory Medicine, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1875, Australia. Email: ccdobler@yahoo.com Received 15 July 2008; accepted 21 October 2008. doi:10.1111/j.1445-5994.2008.01882.x Abstract Background: The aim of this study was to determine the diagnostic yield of flexible bronchoscopy in endoscopically visible malignancies and to evaluate whether cytological examination, including bronchial washings and brush- ings, increase the diagnostic yield compared with bronchial biopsy alone. Methods: We reviewed a series of bronchoscopies over a period of 7.5 years in which an endoscopically visible tumour was identified and which had a definite cytological or histological diagnosis of pulmonary malignancy obtained by bronchoscopy or any other examination. Results: The criteria were met by 174 bronchoscopies. In 155 bronchoscopies all specimens including bronchial washings, brushings and biopsies were obtained; the overall diagnostic yield was 88%. This compared with a diag- nostic yield of 77% for biopsies only (P < 0.001). The individual diagnostic yields for biopsies, brushings and washings were 77, 50 and 38%, respectively. The overall diagnostic yield of cytology was 61%, providing a diagnosis in 95 patients. Of 11 repeat bronchoscopies after an initial non-diagnostic broncho- scopy, 9 were diagnostic. Conclusion: The tumour detection rate with flexible bronchoscopy in endo- scopically visible lung malignancies is high. Cytology-based sampling tech- niques by means of bronchial washings and brushings significantly increase the overall diagnostic yield compared with forceps biopsy only. Repeat bron- choscopies after an initial non-diagnostic bronchoscopy have a relatively high diagnostic yield and should therefore be considered in all patients with endo- scopically visible tumour. Introduction Flexible bronchoscopy plays a central role in the diagno- sis of lung malignancy, especially in endobronchial (endoscopically visible) tumours. Bronchoscopy allows the sampling of cytological specimens as well as biopsies for histological diagnosis. Bronchoscopic cytological methods include bronchial washings, bronchial brush- ings, bronchoalveolar lavage, and transbronchial and endobronchial needle aspirations. When an endobron- chial tumour is visible at bronchoscopy, forceps biopsies are the most common specimen collected and usually have the highest diagnostic yield. In a summary of pub- lished evidence in 2003, the diagnostic yield of biopsies in endobronchial lung cancer was reported to be 74% based on the results of 20 studies. 1 Overall diagnostic yield for all bronchoscopic methods (histology complemented by cytology) was 88% for endobronchial disease. Several studies have provided evidence that the overall Funding: The position of Claudia Dobler is funded by the National Health and Medical Research Council Centre of Clinical Research Excellence in Respiratory and Sleep Medicine, Australia. The funding is independent of this specific study. Conflict of interest: None. Internal Medicine Journal 39 (2009) 806–811 © 2009 The Authors Journal compilation © 2009 Royal Australasian College of Physicians 806