Less than 15% of all patients survive five years after a diagnosis of lung cancer.[6
] In the absence of a reliable screening program less than 15% of patients are diagnosed with an early Stage I cancer. In China and across the globe, 80% of patients are ineligible for surgical resection at diagnosis, mostly because of the advanced stage of cancer and also due to poor general condition. Among the methods used for the diagnosis of lung cancer, bronchoscopy serves as an important tool involved with diagnosis, staging, and management of lung cancer.[7
] Technological advancements have allowed for the emergence of newer modalities to evaluate endobronchial, parenchyma, and mediastinal pathology.[8
] Conventional techniques such as white light video bronchoscopy and its ancillary procedures (forceps biopsy, brush biopsy, bronchoalveolar lavage, bronchial washings, and transbronchial needle aspiration) help with accuracy in relation to tumor location, size, and type. This study aimed to evaluate the contribution of AFB in the diagnosis of lung cancer, on a hospital site, over a period of five years.
The results of our study show that out of 4983 patients, 3314 cases involved male patients, which represents that male subjects more frequently present with lesions apprehensive of lung cancer. This is supported by pathologically confirmed lung cancer in 1148 male subjects, which is in agreement with earlier findings.[9
] Our results substantiate a 3.41 times higher possibility of lung cancer in male subjects taking AFB examination. Moreover, the incidence of squamous cell carcinoma was 54.61% in male and 15.73% in females; a possible explanation to this tendency can be the higher prevalence of smoking among male subjects in China[10
Transbronchial needle aspiration (TBNA) is a minimally invasive and increasingly utilized technique to diagnose and stage lung cancer. Large case series[8
] have reported a diagnostic accuracy of 70-95%, depending upon several factors including operator and cytopathology expertise. In the 1485 diagnosed cases of lung cancer we noted squamous cell carcinoma (45.79%), small cell carcinoma (29.09%), adenocarcinoma (24.98%), and adenosquamous carcinoma (0.14%). These findings advocate that suspicious peripheral and central airway lesions investigated with AFB have a higher chance for pathological confirmation. Hence, AFB examination should be the initial investigation once clinical features are suggestive of a mass bronchial lesion in the chest.[19
] The female cases had a higher incidence of adenocarcinoma (49.85%) and small cell carcinoma (34.42%), which is in agreement with earlier findings related to the occurrence of lung cancer type in female subjects.[11
] We also observed a yearly increase in the incidence of squamous cell carcinoma among female subjects, perhaps increasingly popular smoking behavior is an explanation[22
The results show a positive relation between lung cancer incidence and old age. The high incidence of lung cancer among elderly subjects may be related to factors like smoking status, food habits, occupational exposure and infectious diseases.[20
] Moreover, the lack of observed gender predisposition for lung cancer types among subjects more than 50 years of age supplements ours assumption that the elderly in China are predisposed to malignancy.[27
] Bronchial carcinomas typically involve the main, middle and segmental bronchus. Our results show a higher incidence in the right lung and frequent involvement of the upper lobe. These findings are possibly related to the variation in vascular, lymphatic and anatomic structures. An earlier study[6
] has shown a correlation between morphological abnormality and pathological types. This study found morphological patterns relative to cancer types and provided clues before the pathological confirmation was made. Our study found that adenocarcinoma presents as an invasive pattern; while squamous cell carcinoma and small cell carcinoma have a proliferative presentation under AFB [Tables and ].
Our study has certain limitations; first there is no arm of conservative follow-up. Secondly, it is a single-center study and involves a group of physicians with a similar approach. We believe that a multi-centric study will provide a better approach in the generalization of results.
In conclusion, AFB is efficient in the detection of pre-invasive and invasive bronchial cancer lesions. Our study proposes that AFB may be used in the screening of lung cancer. Though newer technologies, such as narrow band imaging, endoscopic ultrasound, endobronchial ultrasound, electromagnetic navigation, optical coherence tomography, and con-focal fluorescent laser microscopy are favorite clinical investigations in the developed world, they are yet to prove their medico-economic viability in the developing world.