The utility of bronchial brushings in the modern era of flexible bronchoscopy

Introduction: Bronchoscopic procedures allow for the procurement of cellular material for diagnosis, molecular studies, and staging. Procurement modalities include bronchoalveolar lavage (BAL), bronchial washing (BW), transbronchial ultrasound-guided needle aspiration (TBNA), transbronchial biopsy (TBBX), endobronchial biopsy (EB), and bronchoscopic brushing (BB). These specimens, taken concurrently, often circumvent the need for an open biopsy, and allow for more appropriate and efficient patient management. Although BB is a well-established method for obtaining cytologic material, it often introduces artifacts and may contain abundant material such as benign and/or metaplastic bronchial epithelium, both of which may result in atypical or false-positive diagnoses. We examined the utility of BB specimens at our institution in recent years. Methods: 210 BB specimens were identified at our institution over a 2-year period, allowing for at least a 2-year follow-up period. The diagnoses were compiled and compared against results from simultaneously obtained BAL, BW, TBNA, TBBX, and EB specimens, as well as any follow-up during the subsequent 2- to 4-year period. Results: BB specimens were diagnosed as malignant (n = 44), benign (130), indeterminate (30), and non-diagnostic (6). There were no false-positive diagnoses. There were 6 instances in which malignancy was not definitively diagnosed on a non-BB specimen but definitively diagnosed on BB. Conclusion: BB specimens rarely provide the only diagnostic material during a bronchoscopic procedure, though they possess excellent specificity for malignancy. Indeterminate diagnoses have a positive predictive value of approximately 73%.