The value of cytologic examination in the management of lung cancer

Cytologic examination of sputum and other material from the lung is of great value in the diagnosis of lung cancer. If the patient does not expectorate, material can be obtained by bronchoscopic aspiration of secretions, bronchial brushings, bronchial washings, transthoracic needle aspiration and thoracocentesis. Cytologic examination makes it possible not only to diagnose lung cancer but also to determine the exact cell type of the cancer in most cases. Furthermore, such cytologic examinations are of value in cancer metastatic to the lung as well as for primary lung cancer. The risk of a false positive diagnosis is small, especially in laboratories within which sufficient numbers of examinations are performed to maintain the skill of technicians and pathologists. Studies are in progress to evaluate the cost-effectiveness of frequent sputum examinations, along with roentgenograms of the thorax, to detect asymptomatic lung cancer in men at special risk because of their smoking habits. Present data are inadequate to determine the ultimate value of such screening tests for lung cancer. For the time being, each physician must evaluate the risk of lung cancer and recommend what seems reasonable for each patient.