Introduction:   We evaluated the diagnostic results of cytological analysis of bronchial washing in addition to forceps biopsy on the basis of the bronchoscopic appearance and histologic type of lung cancer.

Methods:  This retrospective study included 611 patients who had lung cancer and underwent bronchoscopic procedures between April 2003 and December 2008. Bronchoscopic appearance was classified into six types (tumor, infiltrative, necrotic, normal, compressive and aspecific) on the basis of endoscopic morphology.

Results:  The forceps biopsy was positive in 492 cases (80.5%) and the combination of forceps biopsy with cytological analysis of bronchial washing was diagnostic in 84.1% (514/611 cases), a statistically significant increase of 3.6% (P < 0.001). Cytological analysis of bronchial washing of tumor, infiltrative and necrotic lesions produced higher diagnostic yields than normal, compressive and aspecific lesions (41.7% vs 29.3%), but the diagnostic yield did not increase when combined with forceps biopsy (P > 0.05). However, in normal and compressive lesions, the addition of forceps biopsy to cytological analysis of bronchial washing significantly increased the diagnostic rate (P < 0.05). The histologic type of lung cancer did not significantly affect the difference in the diagnostic rate between forceps biopsy alone and the combination of forceps biopsy and cytological analysis of bronchial washing (P > 0.05).

Conclusions:  The combination of forceps biopsy and washing cytological analysis offers a better diagnostic rate than biopsy alone in diagnosing lung cancer. Both procedures should be performed during bronchoscopy even if no endobronchial lesion is present. © 2012 Blackwell Publishing Ltd.