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A7325 - Is There Utility in Processing Bronchial Brush-Tip Washings for Cytologic Diagnosis?
Author Block: J. Angotti1, P. Branca2, L. Duncan3; 1Internal Medicine, University of Tennessee Medical Center, Knoxville, TN, United States, 2Pulmonary and Critical Care, University of Tennessee Medical Center, Knoxville, TN, United States, 3Pathology, University of Tennessee Medical Center, Knoxville, TN, United States.
Rationale: It is common practice to process a bronchial brushing (whether central or peripheral) by making direct slides (DS) with the brush, then rinsing the brush in sterile saline before its next use. Cytologic analysis of the slides is standard, and in many institutions the saline used to rinse the brush is also processed by centrifugation and creation of additional slides called “brush-tip washings” (BTW). University of Tennessee Medical Center practice was recently changed to perform cultures on brush-tip washings rather than process the fluid for cytologic analysis, based on clinician perception that cytology performed on brush-tip washings would not provide additional yield beyond that from the slides made directly from the bronchial brush. There are, however, little data comparing the two processes. We will attempt to show that BTW do not give additional information than that already obtained by the brushing DS cytology. This is important to know, as we would then have evidence based reasoning to allow elimination of one step in the process of pathologic diagnosis without compromising the sensitivity or specificity of the overall brush test.
Methods: A single center retrospective, observational chart review of patients from 2014-2015 who underwent bronchoscopy with bronchial brushings processed as both direct slides and BTW was completed. A concordance analysis was then performed between direct slides and BTW. 100 patients who had both DS and BTW processes were then reviewed.
Results: Of the 100 patients, there were 42 malignancies confirmed by bronchial brushing. The DS process identified 39 (93%) and the BTW process identified 35 (83%). There were 8 malignancies identified on direct slides where the BTW process was nondiagnostic. Importantly, there were 3 BTW samples that confirmed malignancy while the corresponding DS was nondiagnostic.
Conclusions: The data from our study does reveal that the DS process is relatively more sensitive in detecting malignancy than the BTW process, however our original hypothesis is rejected, since there were 3 cancers detected via BTW that DS did not diagnose. A larger sample number will be helpful in clarification between the two techniques, but based on the results of this study, it appears reasonable to continue performing BTW on suspicious pulmonary lesions.