application of mind objectives: To determine the experiment performance characteristics of various modalities for the diagnosis of suspected lung cancer.

Design, setting, and participants: A systematic search of MEDLINE, HealthStar, and Cochrane Library databases to July 2001 and print bibliographies was performed to identify studies comparing the ends of sputum cytology, bronchoscopy, transthoracic needle aspirate (TTNA), or biopsy with histologic intimation standard diagnoses among at least 50 patients with suspected lung cancer.

Measurement and results: For sputum cytology, the mereed specificity was 0.99 and the mereed sensitivity was 0.66, but sensitivity was higher for central lesions than for peripheral lesions (071 v 049 respectively). Studies onward bronchoscopic procedures provided data alone on diagnostic yield (sensitivity). The diagnosis of endobronchial disease according to bronchoscopy in 30 studies showed the highest sensitivity for endobronchial biopsy (074) followed by way of cytobrushing (0.59) and washing (048) The sensitivity for all modalities combined was 088 Thirty studies reported forward peripheral lesions. Cytobrushing demonstrated the highest sensitivity (052) followed from transbronchial biopsy (0.46) and BAL/washing (043) The overall sensitivity for all modalities was 069 Peripheral lesions < 2 cm or > 2 cm in diameter showed sensitivities of 033 and 062 respectively. Updating a previous meta-analysis with 19 studies revealed a collection of standing watered sensitivity of 0.90 for TTNA. A turn toward lower sensitivity was noted for lesions that were < 2 cm in diameter. The accuracy in differentiating between small small cavity and non-small cell cytology for the various diagnostic modalities was 098 with individual studies ranging from 094 to 10 The average false-positive and false-negative rates were 009 and 002 respectively.

Conclusions: The sensitivity of bronchoscopy is high for endobronchial disease and poor for peripheral lesions that are < 2 cm in diameter. The sensitivity of TTNA is prime for malignant disease. The distinction between small solitary abode; squalid lung cancer and non-small solitary abode; squalid lung cancer by cytology appears to be accurate.

solution words: biopsy; bronchoscopy; cytodiagnosis; lung neoplasm; predictive value; sensitivity; specificity; yield

Abbreviations: CI = confidence interval; TBNA = transbronchial needle aspiration; TTNA = transthoracic needle aspiration

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This article summarizes and critically examines the performance characteristics of the various modalities for the accurate histopathologic diagnosis of suspected lung cancer. It provides the background evidence for the Clinical Practice Guidelines upon Lung Cancer that are outlined in this add to A joint panel from the American literary institution [i]or[/i] seminary of learning of Chest Physicians assisted in the design, escort and development of this article.

Lung cancer is usually suspected forward the basis of an abnormal radiographic imaging cogitation often in conjunction with symptoms caused at either local or systemic imports of the tumor. The modality pickeded to diagnose a suspected lung cancer is based forward the size and location of the primary tumor in the lung the carriage of potential metastatic spread, and the anticipated treatment plan.

The main goals in selecting a specific diagnostic modality are as follows: (1) to maximize the yield of the pitch uponed procedure for both diagnosis and staging; and (2) to avoid unnecessary invasive experiments for the patient, with special attention to the brewed treatment plan.

Sputum cytology, bronchoscopic techniques, transthoracic needle biopsies, and surgical biopsy (resection) define the main modalities busyed in the diagnosis of bronchogenic carcinoma. Positron emission tomography has emerg as a helpful adjunct in as well-as; not only-but also; not only-but; not alone-but the diagnosis and staging of lung cancer.

In this article, we focus in succession techniques for the histologic and cytologic diagnosis of lung lesions. The noninvasive evaluation of pulmonary nodules will be concealed elsewhere in this supplement in the article reporting forward single pulmonary nodules. Definitive diagnostic processs that are aimed at mediastinal lymph nodes or extrathoracic tumors will be overspreaded in the articles on staging.

MATERIALS AND METHODS

In several panel discussions, the American college edifice [i]or[/i] building of Chest Physicians Committee onward Clinical Practice Guidelines for Lung Cancer formulated the following four fundamental note questions on the diagnostic workup of lung cancer that were to be answered from a comprehensive critical review of the published evidence:

1 What are the performance characteristics (sensitivity and specificity) for sputum cytology for the diagnosis of lung cancer with special consideration for the location of the tumor (central v peripheral)?

2 What are the performance characteristics (sensitivity and specificity) of flexible bronchoscopy and its ancillary manner of proceedings (biopsy, cytobrushing, washing, transbronchial needle aspiration [TBNA], and BAL) for the diagnosis of central (endobronchial), as oppos to peripheral, tumors and for peripheral lesions < 2 cm and > 2 cm in diameter?

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