Bronchial cytology and fine needle aspiration are important techniques for diagnosing lung lesions. Bronchial cytology examines the central airways using bronchoscopy while fine needle aspiration can sample peripheral lung lesions. Normal respiratory cells include ciliated bronchial cells and alveolar macrophages. Benign lesions may show goblet cell or basal cell hyperplasia. Non-neoplastic lung diseases like sarcoidosis and pulmonary alveolar proteinosis can also be diagnosed through their characteristic cytology findings. Cytology is useful for identifying infection causes as well as diagnosing and classifying lung tumors.

1. Benign and MalignantBenign and Malignant
Lesions in RespiratoryLesions in Respiratory
CytologyCytology
MISS SURUTTAYA CHINNAWONGMISS SURUTTAYA CHINNAWONG

2. Respiratory CytologyRespiratory Cytology
• Major role:
– Diagnosis of malignant neoplasms
involving lung both primary and
metastatic
• Minor role:
– Opportunistic infection
– Specific inflammatory process
– Benign neoplasms, some

3. Sampling techniquesSampling techniques
• Exfoliative methods
– Sputum cytology
– Bronchial cytology (BW and BB)
– Bronchoalveolar lavage (BAL)
• Fine needle aspiration (FNA)

4. Exfoliative methodsExfoliative methods
• Factors influences diagnostic yields
– Tumor mass
• Location, size, histologic type
– Infiltrative lesion: inflammation
• Diffuse process or localized process
• Sensitivity and specificity
• False negative diagnoses

6. Sputum CytologySputum Cytology
• Symptomatic patients
• Techniques:
– ”pick and smear”
– Saccomanno
– Cytospin or monolayer
• Advantages:
• Disadvantages

7. Advantages of sputumAdvantages of sputum
• Noninvasive
• Reflect constituents from many regions of
lung
• Useful for centrally located malignancies
(Squamous cell/Small cell CA)
• High diagnostic yields: induced sputum, 3-5
samples continuously examined
• Chronic inflammations: Asthma, COPD
• Respiratory infections

8. Disadvantages of sputumDisadvantages of sputum
• Alveolar macrophages: lower respiratory
tract elements
• Localized lung lesion, peripheral lesion
• Adenocarcinoma, metastatic lesion,
lymphoma
• Benign tumor

9. Bronchial cytologyBronchial cytology
• Fiberoptic bronchoscopy
• Bronchoscope positions at the area
of abnormality
• Adequacy: large number of bronchial
epithelial cells and alveolar
macrophages
• Inadequate specimen: heavy oral
contamination, obscuring blood,
inflammatory process, dried artefact

10. Bronchial cytology:Bronchial cytology:
disadvantagesdisadvantages
• Limited area of the lung examined by
bronchoscopy
• Invasive procedure: unpleasant for the
patients
• Benign tumors, extremely peripheral
lesions

11. Bronchoalveolar lavageBronchoalveolar lavage
• The most distal airspaces
• Diffuse disease process
• Pulmonary infection: opportunistic
infections
• Interstitial lung disease
• Lymphoproliferative disorders
• Malignancy

12. BAL cytologyBAL cytology
• Adequacy: abundant alveolar
macrophages
• Inadequacy: bronchial epithelial cells
or squamous cells >75%

14. FNA cytologyFNA cytology
• Percutaneous transthoracic FNA
– Direct lung tap
– CT-guided FNAB
• Transbronchial (Wang’s needle) FNA
– Bronchoscopy
– Staging of lung tumors
• Hilar nodes
• Mediastinal nodes
• Subcarinal nodes

15. FNA lung lesionFNA lung lesion
• Sensitivity: 75-95%
• Specificity: 95-100%
• Classification of tumor: 70-85%
• Complications: lesion depth/size,
needle
– Pneumothorax: 5-10% need treatment
– Hemoptysis
– Air embolism

16. Normal ElementsNormal Elements
• Upper respiratory tract
– Nonkeratinizing stratified squamous cells
• Lower respiratory tract
– Ciliated columnar bronchial epithelial cells
– Goblet cells
– Alveolar pneumocytes
• Reactive changes
– Flat cohesive sheets
– Multinucleated ciliated cells

22. Benign cellularBenign cellular
proliferationsproliferations
• Creola body
– Bronchial cell hyperplasia
• Goblet cell hyperplasia
– Mucin vacuoles with small nuclei
• Reserved cell
– Basal cells with molded nuclei

28. Noncellular componentsNoncellular components
• Corpora amylacea: noncalcified
concretions
• Psammoma bodies
• Ferruginous bodies
• Charcot-Layden crystals
• Curschmann spirals
• Contaminants: pollen, food

33. Nonneoplastic lungNonneoplastic lung
diseasedisease
• Sarcoidosis
– Granulomatous inflammation of lung
parenchyma with hilar/mediastinal node
involement
– FNA diagnosis
– Diagnosis includes typical features of
nonnecrotizing granuloma and exclusion
of specific infectious etiology
– Culture and special stains needed

34. Noneoplastic lung diseaseNoneoplastic lung disease
• Pulmonary alveolar proteinosis
– BAL diagnosis
• Gross: cloudy/milky white with graular
debris
– Paucicellular sample of mononuclear
inflammatory cells
– Amorphous basophilic granular debris
– D/Dx: Pneumocystosis, Nocardia,
amyloidosis

35. erin pigments in alveolar macropha

37. Pulmonary InfectionPulmonary Infection
• Viral infection
– BAL diagnosis
– Cilicytophthoria: detachment of cilia
• Adenovirus infection
– Reactive epithelial atypia
– Specific viral inclusions