Diagnostic yield of pre- versus post-biopsy bronchial washing in endobronchial cancer: Impact of procedural sequence

BACKGROUND:
Fiberoptic bronchoscopy is a crucial diagnostic tool in the evaluation of lung cancer, particularly in tumors with endobronchial involvement. While forceps biopsy, bronchial brushing, and bronchial washing are commonly used, the diagnostic value and optimal timing of bronchial washing remain debatable.


OBJECTIVES:
To evaluate the effect of pre- and post-biopsy bronchial washing on cytological diagnostic yield in patients with visible endobronchial lesions.


DESIGN:
Prospective diagnostic study


SETTINGS:
Single tertiary university hospital


MATERIALS AND METHODS:

Between April 2018 and April 2021, 55 patients with bronchoscopically visible endobronchial lesions underwent flexible bronchoscopy. Patients with invisible or submucosal tumors were excluded. Bronchial washings were obtained before and after 4–6 forceps biopsies. Cytological analyses were conducted blindly on all specimens. Statistical analysis included Chi-square and McNemar tests, with
P
<.05 considered significant.



MAIN OUTCOME MEASURES:
Cytological diagnostic positivity rates in pre- and post-biopsy bronchial washings.


SAMPLE SIZE:
Fifty-five patients


RESULTS:

Forceps biopsy alone achieved a diagnostic yield of 95%, which increased to 96% when combined with bronchial washing. Post-biopsy washing demonstrated a significantly higher cytological positivity rate (47%) than pre-biopsy washing (22%) (
P
=.002). No complications were observed.



CONCLUSIONS:
Bronchial washing after forceps biopsy significantly improves cytological diagnostic yield in endobronchial lung lesions. Its simplicity, low cost, and additional diagnostic yield support its routine use in bronchoscopic evaluation.


LIMITATIONS:
Single-center design and relatively small sample size; other cytologic methods such as brushing orendobronchial ultrasound (EBUS) were not evaluated.