Objectives: Immunohistochemistry (IHC) is an important component of lung cancer diagnosis and management, although performance can be limited due to tissue availability. We describe a novel technique for processing brush-tip washings (BTW) and evaluate the feasibility of IHC testing on these samples. Study Design: All patients who had cell blocks (CB) created from BTW following bronchoscopic investigation of peripheral lung lesions were included. CB were assessed for adequate material before undergoing IHC staining. Results: 75 patients were included in the study, with bronchoscopic diagnosis of malignancy achieved in 77%. Sixty-seven samples (89%) had sufficient cells for diagnosis on CB and 56 of these (84%) proved amenable to IHC. CB created from BTW were the sole specimens available for IHC subtyping in 7 patients (9%). Conclusions: CB are easily created from BTW and are a simple method for increasing the diagnostic utility of bronchoscopic specimens without increasing the risk or duration of bronchoscopy. IHC can be easily performed in a high proportion of cases, increasing the likelihood of accurate sub-typing of tumours following diagnostic bronchoscopy.

Keywords:
Cell block, Immunohistochemistry, Lung cancer, Brush-tip washings
1.
Capelozzi VL: Role of immunohistochemistry in the diagnosis of lung cancer. J Bras Pneumol 2009;35:375-382.
2.
Jagirdar J: Application of immunohistochemistry to the diagnosis of primary and metastatic carcinoma to the lung. Arch Pathol Lab Med 2008;132:384-396.
3.
Rossi A, Maione P, Bareschino MA, Schettino C, Sacco PC, Ferrara ML, Castaldo V, Gridelli C: The emerging role of histology in the choice of first-line treatment of advanced non-small cell lung cancer: implication in the clinical decision-making. Curr Med Chem 2010;17:1030-1038.
4.
Pallis AG, Serfass L, Dziadziusko R, van Meerbeeck JP, Fennell D, Lacombe D, Welch J, Gridelli C: Targeted therapies in the treatment of advanced/metastatic NSCLC. Eur J Cancer (Oxford) 2009;45:2473-2487.
5.
Karahalli E, Yilmaz A, Türker H, Ozvaran K: Usefulness of various diagnostic techniques during fiberoptic bronchoscopy for endoscopically visible lung cancer: should cytologic examinations be performed routinely? Respiration 2001;68:611-614.
6.
Roth K, Hardie JA, Andreassen AH, Leh F, Eagan TM: Predictors of diagnostic yield in bronchoscopy: a retrospective cohort study comparing different combinations of sampling techniques. BMC Pulm Med 2008;8:2.
7.
Rivera MP, Mehta AC, Wahidi MM: Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, ed 3: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013;143:e142S-e165S.
8.
Kossakowski CA, Morresi-Hauf A, Schnabel PA, Eberhardt R, Herth FJF, Warth A: Preparation of cell blocks for lung cancer diagnosis and prediction: protocol and experience of a high-volume center. Respiration 2014;87:432-438.
9.
Steinfort DP, Vincent J, Heinze S, Antippa P, Irving LB: Comparative effectiveness of radial probe endobronchial ultrasound versus CT-guided needle biopsy for evaluation of peripheral pulmonary lesions: a randomized pragmatic trial. Respir Med 2011;105:1704-1711.
10.
Steinfort DP, Leong TL, Laska IF, Beaty A, Tsui A, Irving LB: Diagnostic utility and accuracy of rapid on-site evaluation of bronchoscopic brushings. Eur Respir J 2015;45:1653-1660.
11.
Shiner RJ, Rosenman J, Katz I, Reichart N, Hershko E, Yellin A: Bronchoscopic evaluation of peripheral lung tumours. Thorax 1988;43:887-889.
12.
Popp W, Rauscher H, Ritschka L, Redtenbacher S, Zwick H, Dutz W: Diagnostic sensitivity of different techniques in the diagnosis of lung tumors with the flexible fiberoptic bronchoscope. Comparison of brush biopsy, imprint cytology of forceps biopsy, and histology of forceps biopsy. Cancer 1991;67:72-75.
13.
Kawaraya M, Gemba K, Ueoka H, Nishii K, Kiura K, Kodani T, Tabata M, Shibayama T, Kitajima T, Tanimoto M: Evaluation of various cytological examinations by bronchoscopy in the diagnosis of peripheral lung cancer. Br J Cancer 2003;89:1885-1888.
14.
Rosell A, Monsó E, Lores L, Vilà X, Llatjós M, Ruiz J, Morera J: Cytology of bronchial biopsy rinse fluid to improve the diagnostic yield for lung cancer. Eur Respir J 1998;12:1415-1418.
15.
Uchida J, Imamura F, Takenaka A, Yoshimura M, Ueno K, Oda K, Nakayama T, Tsukamoto Y, Higashiyama M, Kusunoki Y: Improved diagnostic efficacy by rapid cytology test in fluoroscopy-guided bronchoscopy. J Thorac Oncol 2006;1:314-318.
16.
Fernández-Bussy S, Labarca G, Zagolin M, Oyonarte M, Isamit D, Jalilie A, Guerra C, Chernilo S: Immediate complications following flexible bronchoscopy: retrospective analysis of 1,079 procedures (in Spanish). Rev Med Chil 2014;142:299-304.
17.
Boonsarngsuk V, Kanoksil W, Laungdamerongchai S: Diagnosis of peripheral pulmonary lesions with radial probe endobronchial ultrasound-guided bronchoscopy. Arch Bronconeumol 2014;50:379-383.
18.
Steinfort DP, Khor YH, Manser RL, Irving LB: Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. Eur Respir J 2011;37:902-910.
19.
Sanz-Santos J, Serra P, Andreo F, Llatjós M, Castella E, Monsó E: Contribution of cell blocks obtained through endobronchial ultrasound-guided transbronchial needle aspiration to the diagnosis of lung cancer. BMC Cancer 2012;12:34.
20.
Tsai TH, Yang CY, Ho CC, Liao WY, Jan IS, Chen KY, Wang JY, Ruan SY, Yu CJ, Yang JC, Yang PC, Shih JY: Multi-gene analyses from waste brushing specimens for patients with peripheral lung cancer receiving EBUS-assisted bronchoscopy. Lung Cancer 2013;82:420-425.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.