title: The optimal sequence for bronchial brushing and forceps biopsy in lung cancer diagnosis: a random control study.
abstract: BACKGROUND
  Optimizing basic techniques in diagnostic bronchoscopy is important for improving medical services in developing countries. In this study, the optimal sequence of bronchial brushing relative to bronchial biopsy for lung cancer diagnosis was evaluated.
  
  
  METHODS
  A total of 420 patients with visible endobronchial tumors were prospectively and randomly enrolled in two groups: a pre-biopsy brushing group, receiving two brushings before biopsy; two brushings which performed afterwards; were set as self-control and compared with the pre-biopsy brushings as the intra-group comparison; and a post-biopsy brushing group, only receiving two brushings after biopsy, which were compared with the pre-biopsy brushings as the inter-group comparison. Diagnostic yield of brushing was compared before and after biopsy, and as well as for different tumor pathologies and bronchoscopic morphologies. The occurrence of treated bleeding which defined as bleeding needed further intervention with argon plasma coagulation and/or anti-coagulation drugs in two groups was also compared.
  
  
  RESULTS
  Only patients with a definitive cytological or histological diagnosis of lung cancer based on bronchoscopy or other confirmatory techniques were included. Patients were excluded if they had submucosal lesions, extrinsic compressions, pulmonary metastasis of extrapulmonary malignancies or uncommon non-small cell lung carcinoma (NSCLC). A total of 362 patients who met the inclusion criteria were analyzed. Diagnostic yield for pre-biopsy brushing (49.2%, 88/179) was significantly higher than for post-biopsy brushing within the same pre-biopsy brushing group (31.8%, 57/179) (P=0.007) as the intra-group comparison, and significantly higher than for post-biopsy brushing in the post group (30.6%, 56/183) (P<0.001) as the inter-group comparison. No difference in occurrence of treated bleeding for pre- vs. post-biopsy bronchial brushing was found.
  
  
  CONCLUSIONS
  Supplementing bronchoscopic forceps biopsy with brushing improves diagnostic yield in lung cancer. In cases of endobronchial exophytic tumors, pre-biopsy brushing appears to be superior to post-biopsy brushing.
authors.affiliation: 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Hou
authors.affiliation: 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Miao
authors.affiliation: 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China.
authors.forename: Xue-Jun
authors.initials: XJ
authors.lastname: Hu
authors.affiliation: 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China.
authors.forename: Qiu-Yue
authors.initials: QY
authors.lastname: Wang
authors.affiliation: 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China.
authors.forename: Guang-Ping
authors.initials: GP
authors.lastname: Wu
authors.affiliation: 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China.
authors.forename: En-Hua
authors.initials: EH
authors.lastname: Wang
authors.affiliation: 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Kang
keywords: Forceps biopsy; bronchoscopy; brushing; lung cancer