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Hoffmann, R. A wiki for the life sciences where authorship matters. Nature Genetics (2008)

Changing cytologic and histologic utilization patterns in the diagnosis of 515 primary lung malignancies.

BACKGROUND: Over the last decade, the specimen types used to diagnose primary pulmonary malignancies at the authors' institution have changed in terms of their frequency of submission. METHODS: The authors reviewed pathologic findings in 216 cases of primary lung carcinoma diagnosed during the years 1983-1984 (earlier period) and compared these with the findings in 299 cases diagnosed during the years 1993-1994 (later period). RESULTS: The total number of transbronchial fine-needle aspirates (TBNA) increased from 13 to 206 (P < 0.0001), the total number of sputum (SP) samples declined from 236 to 36 (P < 0.0001), and the total number of forceps endobronchial biopsy ( FBX) specimens increased from 61 to 119 (P = 0.0023) between the earlier period and the later period. The positivity rate of some specimen types was similar for these two periods (transthoracic percutaneous fine-needle aspirate [PFNA], 95% and 97%; bronchial washings, 61% and 60%), but the positivity of others improved by a statistically nonsignificant degree (bronchial brushings, 61-71%; FBX, 59-69%). The positivity of TBNA was 57% in 1993-1994. The collective positivity of bronchoscopic cytology specimens was significantly higher than simultaneous FBX during both periods (P = 0.0032), but bronchoscopic histology and cytology were complementary. The positivity of fiberoptic bronchoscopy (FOB) improved significantly, from 72% in 1983-1984 to 85% in 1993-1994 (P = 0.0059). During both periods, an equivalent proportion of patients were subjected to each of 3 major invasive sampling procedures (FOB, 70%; PFNA, 20%; open surgical biopsy, 10%). Fifteen patients were diagnosed by SP cytology without an invasive procedure in 1983-1984, but none were diagnosed by SP cytology in 1993-1994. CONCLUSIONS: TBNA and increased utilization of FBX have displaced postbronchoscopy SP examination, generating higher positivity for FOB. Bronchoscopic cytology and histology were complementary, but radiologically guided fine-needle aspiration was the procedure with the highest positivity.[1]


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