Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence.

STUDY OBJECTIVES To determine the test performance characteristics of various modalities for the diagnosis of suspected lung cancer. DESIGN, SETTING, AND PARTICIPANTS A systematic search of MEDLINE, HealthStar, and Cochrane Library databases to July 2001 and print bibliographies was performed to identify studies comparing the results of sputum cytology, bronchoscopy, transthoracic needle aspirate (TTNA), or biopsy with histologic reference standard diagnoses among at least 50 patients with suspected lung cancer. MEASUREMENT AND RESULTS For sputum cytology, the pooled specificity was 0.99 and the pooled sensitivity was 0.66, but sensitivity was higher for central lesions than for peripheral lesions (0.71 vs 0.49, respectively). Studies on bronchoscopic procedures provided data only on diagnostic yield (sensitivity). The diagnosis of endobronchial disease by bronchoscopy in 30 studies showed the highest sensitivity for endobronchial biopsy (0.74), followed by cytobrushing (0.59) and washing (0.48). The sensitivity for all modalities combined was 0.88. Thirty studies reported on peripheral lesions. Cytobrushing demonstrated the highest sensitivity (0.52), followed by transbronchial biopsy (0.46) and BAL/washing (0.43). The overall sensitivity for all modalities was 0.69. Peripheral lesions < 2 cm or > 2 cm in diameter showed sensitivities of 0.33 and 0.62, respectively. Updating a previous meta-analysis with 19 studies revealed a pooled sensitivity of 0.90 for TTNA. A trend toward lower sensitivity was noted for lesions that were < 2 cm in diameter. The accuracy in differentiating between small cell and non-small cell cytology for the various diagnostic modalities was 0.98, with individual studies ranging from 0.94 to 1.0. The average false-positive and false-negative rates were 0.09 and 0.02, respectively. CONCLUSIONS The sensitivity of bronchoscopy is high for endobronchial disease and poor for peripheral lesions that are < 2 cm in diameter. The sensitivity of TTNA is excellent for malignant disease. The distinction between small cell lung cancer and non-small cell lung cancer by cytology appears to be accurate.

[1]  Percutaneous needle biopsy of the lung. , 1967, Archives of internal medicine.

[2]  M. V. van’t Hof,et al.  Sputum cytology by the saccomanno method in diagnosing lung malignancy , 1985, Diagnostic cytopathology.

[3]  A. Miller,et al.  The diagnosis of primary lung cancer with special reference to sputum cytology. , 1971, Thorax.

[4]  H. vine,et al.  Percutaneous lung biopsy using the Lee needle and a track-obliterating technique. , 1982, Radiology.

[5]  C. Geller,et al.  Diagnosis of bronchogenic carcinoma through the cytologic examination of sputum, with special reference to tumor typing. , 1976, Acta cytologica.

[6]  L. Tao,et al.  Preliminary experience with a dual cutting edge needle in thoracic percutaneous fine-needle aspiration biopsy. , 1987, Radiology.

[7]  W. Lees,et al.  Five years' experience of fine-needle aspiration biopsy: 454 consecutive cases. , 1985, Clinical radiology.

[8]  M. Ig,et al.  CT-Guided Cutting Needle Biopsy of Lung Lesions - Safety and Efficacy of an Out-patient Service , 2000 .

[9]  Ruizong Li,et al.  Percutaneous transthoracic needle biopsy of the lung: review of 612 lesions. , 1998, Journal of vascular and interventional radiology : JVIR.

[10]  Yung‐Chie Lee,et al.  Ultrasonographically guided biopsy of thoracic tumors. A comparison of large‐bore cutting biopsy with fine‐needle aspiration , 1992, Cancer.

[11]  T. Vogl,et al.  CT-guided percutaneous core biopsies of pulmonary lesions: Diagnostic accuracy, complications and therapeutic impact , 2001, Acta radiologica.

[12]  U. Tylén,et al.  Fine-needle biopsy of chest lesions. , 1982, Der Radiologe.

[13]  P. Kvale,et al.  Diagnostic accuracy in peripheral lung lesions. Factors predicting success with flexible fiberoptic bronchoscopy. , 1979, Chest.

[14]  S. Rennard,et al.  Clinical guidelines and indications for bronchoalveolar lavage (BAL): pulmonary malignancies. , 1990, The European respiratory journal.

[15]  J. Prolla,et al.  Cytology in diagnosis of cancer affecting the lung. Results in 1,000 consecutive patients. , 1973, Chest.

[16]  G. Buccheri,et al.  Diagnostic, morphologic, and histopathologic correlates in bronchogenic carcinoma. A review of 1,045 bronchoscopic examinations. , 1991, Chest.

[17]  King Eb,et al.  Needle aspiration biopsy of the lung--technique and cytologic morphology. , 1967 .

[18]  D. Naidich,et al.  Solitary Pulmonary Nodules: CT-Bronchoscopic Correlation , 1988 .

[19]  G. M. Stevens,et al.  Outpatient needle biopsy of the lung: its safety and utility. , 1984, Radiology.

[20]  R. D. Johnson,et al.  Current status of radiologically directed pulmonary thin needle aspiration biopsy. An analysis of 200 consecutive biopsies and review of the literature. , 1983, Annals of clinical and laboratory science.

[21]  J. M. Viguer,et al.  Value OF CT-Guided Fine Needle Aspiration in Solitary Pulmonary Nodules with Negative Fiberoptic Bronchoscopy , 1994, Acta radiologica.

[22]  G. Guyatt,et al.  Transthoracic needle aspiration biopsy for the diagnosis of localised pulmonary lesions: a meta-analysis. , 1999, Thorax.

[23]  E A Millar,et al.  The Scottish multi-centre prospective study of bronchoscopy for bronchial carcinoma and suggested audit standards. , 1998, Respiratory medicine.

[24]  D. Cowan,et al.  The reliability of fine‐needle aspiration biopsy in the diagnosis of deep lesions of the lung and mediastinum: Experience with 250 cases using a modified technique , 1987, Diagnostic cytopathology.

[25]  R. E. Clark,et al.  Percutaneous transthoracic aspiration needle biopsy. , 1978, The Annals of thoracic surgery.

[26]  S. Nakamura,et al.  Bronchial brushing and bronchial biopsy: comparison of diagnostic accuracy and cell typing reliability in lung cancer. , 1986, Thorax.

[27]  V Latrabe,et al.  CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm: results with an automated 20-gauge coaxial cutting needle. , 2000, Clinical radiology.

[28]  L. Mccormack,et al.  Aspiration biopsies of chest lesions. , 1978, Radiology.

[29]  S. Jay,et al.  Diagnostic sensitivity and specificity of pulmonary cytology: comparison of techniques used in conjunction with flexible fiber optic bronchoscopy. , 1980, Acta cytologica.

[30]  W F Taylor,et al.  Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study. , 2015, The American review of respiratory disease.

[31]  U. Çağırıcı,et al.  Comparison of endobronchial needle aspiration with forceps and brush biopsies in the diagnosis of endobronchial lung cancer. , 1997, Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace.

[32]  M. Levine,et al.  Transthoracic needle aspiration biopsy following negative fiberoptic bronchoscopy in solitary pulmonary nodules. , 1988, Chest.

[33]  F. Gleeson,et al.  An evaluation of computed tomography as an aid to diagnosis in patients undergoing bronchoscopy for suspected bronchial carcinoma. , 2000, Clinical radiology.

[34]  P. Anton,et al.  Diagnosis and staging of bronchogenic carcinoma by transtracheal and transbronchial needle aspiration. , 1995, Annals of oncology : official journal of the European Society for Medical Oncology.

[35]  E. Edell,et al.  The role of transcarinal needle aspiration in the staging of bronchogenic carcinoma. , 1993, Chest.

[36]  D. Francis.  Aspiration biopsies from diagnostically difficult pulmonary lesions. A consecutive case material. , 2009, Acta pathologica et microbiologica Scandinavica. Section A, Pathology.

[37]  R. Greene,et al.  A study of variability in cytologic diagnoses based on pulmonary aspiration specimens. , 1980, American journal of clinical pathology.

[38]  H. Yazdi,et al.  Thoracic fine needle aspiration biopsy versus fine needle cutting biopsy. A comparative study of 40 patients. , 1988, Acta cytologica.

[39]  G. Gibson,et al.  Prospective evaluation of fine needle aspiration in the diagnosis of lung cancer. , 1988, Thorax.

[40]  W. Black,et al.  The clinical outcome of needle aspirations of the lung when cancer is not diagnosed. , 1986, The Annals of thoracic surgery.

[41]  M. Zorman,et al.  Bronchoalveolar lavage in the diagnosis of peripheral primary and secondary malignant lung tumors. , 1994, Respiration; international review of thoracic diseases.

[42]  S. Kuper,et al.  The Diagnosis of Lung Cancer by Examination of Sputum , 1963, Thorax.

[43]  J. Westcott,et al.  Transthoracic needle biopsy of small pulmonary nodules. , 1997, Radiology.

[44]  W. Seed,et al.  Interpretation of negative results in fine needle aspiration of discrete pulmonary lesions. , 1986, Thorax.

[45]  Mountain Cf,et al.  Cytodiagnosis of lung cancer: a report of four-year laboratory, clinical study with a review of the literature on lung cancer and pulmonary cytology. , 1963 .

[46]  D. Matchar,et al.  Cost-effectiveness of collecting routine cytologic specimens during fiberoptic bronchoscopy for endoscopically visible lung tumor. , 1996, Chest.

[47]  D. Zavala.  Diagnostic fiberoptic bronchoscopy: Techniques and results of biopsy in 600 patients. , 1975, Chest.

[48]  A. Mehta,et al.  Utility of transbronchial needle aspiration in the diagnosis of endobronchial lesions. , 1999, Chest.

[49]  S. Gasparini,et al.  Integration of transbronchial and percutaneous approach in the diagnosis of peripheral pulmonary nodules or masses. Experience with 1,027 consecutive cases. , 1995, Chest.

[50]  J. Christensen,et al.  Ultrasonographically Guided Fine-Needle Aspiration Biopsy of Intrathoracic Tumors , 1996, Acta radiologica.

[51]  L. Pourcelot,et al.  Peripheral Pulmonary Lesions: Ultrasonic Features and Ultrasonically Guided Fine Needle Aspiration Biopsy , 1993, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[52]  A. Yuan,et al.  Ultrasound-guided aspiration biopsy of small peripheral pulmonary nodules. , 1992, Chest.

[53]  D. Sinclair,et al.  Assessment of factors influencing the result of sputum cytology in bronchial carcinoma. , 1981, Thorax.

[54]  I. Ramzy,et al.  Transbronchial fine-needle aspiration. Reliability and limitations. , 1989, American journal of clinical pathology.

[55]  G. M. Stevens,et al.  Needle aspiration biopsy of localized pulmonary lesions with amplified fluoroscopic guidance. , 1968, The American journal of roentgenology, radium therapy, and nuclear medicine.

[56]  W. Scott,et al.  Percutaneous transthoracic needle aspiration biopsy: a comprehensive review of its current role in the diagnosis and treatment of lung tumors. , 1998, Chest.

[57]  A. Deutsch,et al.  Flexible fiberoptic bronchoscopy and percutaneous needle lung aspiration for evaluating the solitary pulmonary nodule. , 1982, Chest.

[58]  L. Santambrogio,et al.  CT-guided fine-needle aspiration cytology of solitary pulmonary nodules: a prospective, randomized study of immediate cytologic evaluation. , 1997, Chest.

[59]  T. Yoneyama,et al.  From "exfoliative" to "diagnostic" cytology. A statistical evaluation of pulmonary cytology. , 1978, Acta cytologica.

[60]  O Lucidarme,et al.  Intrapulmonary lesions: percutaneous automated biopsy with a detachable, 18-gauge, coaxial cutting needle. , 1998, Radiology.

[61]  Xiao-man Liang.  Accuracy of cytologic diagnosis and cytotyping of sputum in primary lung cancer: Analysis of 161 cases , 1989, Journal of surgical oncology.

[62]  C. Bolliger,et al.  The value of transbronchial needle aspiration in the diagnosis of peripheral pulmonary lesions. , 1999, Chest.

[63]  B. Harrison,et al.  Percutaneous Trucut lung biopsy in the diagnosis of localised pulmonary lesions. , 1984, Thorax.

[64]  B. Lind,et al.  Comparison between diagnostic results obtained by transthoracic needle biopsy and by sputum cytology. , 1972, Acta cytologica.

[65]  J. Vestbo,et al.  Value of Tru-cut lung biopsy in focal and diffuse lung disease. , 1988, Thorax.

[66]  S. Schabel,et al.  Lung lesions: cytologic diagnosis by fine-needle biopsy. , 1987, Radiology.

[67]  J. Westcott.  Direct percutaneous needle aspiration of localized pulmonary lesions: result in 422 patients. , 1980, Radiology.

[68]  N. Milman,et al.  Diagnostic yield of transthoracic needle aspiration biopsy following negative fiberoptic bronchoscopy in 103 patients with peripheral circumscribed pulmonary lesions. , 1995, Respiration; international review of thoracic diseases.

[69]  N. Milman,et al.  Percutaneous transthoracic fine-needle lung biopsy with 3 different needles. A retrospective study of results and complications in 224 patients. , 1993, Respiration; international review of thoracic diseases.

[70]  N Yanase,et al.  Diagnosis of peripheral lung cancer in cases of tumors 2 cm or less in size. , 1989, Chest.

[71]  M. Melamed,et al.  Transthoracic aspiration cytology of pulmonary lesions. , 1986, Seminars in diagnostic pathology.

[72]  I. D. Johnston,et al.  Value of washings and brushings at fibreoptic bronchoscopy in the diagnosis of lung cancer. , 1990, Thorax.

[73]  N. Chierakul,et al.  Diagnostic value of bronchoalveolar lavage and postbronchoscopic sputum cytology in peripheral lung cancer , 1998, Respirology.

[74]  N. Russell,et al.  Relationship of radiologic position to the diagnostic yield of fiberoptic bronchoscopy in bronchial carcinoma. , 1984, Chest.

[75]  D. Simmons,et al.  Fiberoptic bronchoscopy in the diagnosis of lung cancer comparison of pre-and post-bronchoscopy sputa, washings, bruchings and biopsies. , 1977, Acta cytologica.

[76]  R. O’Toole,et al.  Use of the Rotex needle in percutaneous biopsy of pulmonary malignancy. , 1985, AJR. American journal of roentgenology.

[77]  F. Rilke,et al.  Cytologic diagnosis of pulmonary carcinoma on bronchoscopic brushing material. , 1982, Acta cytologica.

[78]  C. Flower,et al.  Percutaneous needle biopsy of thoracic lesions--an evaluation of 300 biopsies. , 1979, Clinical radiology.

[79]  Koss Lg,et al.  PULMONARY CYTOLOGY--A BRIEF SURVEY OF DIAGNOSTIC RESULTS FROM JULY 1ST 1952 UNTIL DECEMBER 31ST, 1960. , 1964 .

[80]  F. Burbank,et al.  Image-guided automated core biopsies of the breast, chest, abdomen, and pelvis. , 1994, Radiology.

[81]  H. Eisenberg,et al.  Lung cancer cell type as a determinant of bronchoscopy yield. , 1983, Chest.

[82]  R. Poe,et al.  Sensitivity and specificity of needle biopsy in lung malignancy. , 1980, The American review of respiratory disease.

[83]  R. Farabi,et al.  Fine needle aspiration biopsy in the diagnosis of intrathoracic masses. , 1992, Acta cytologica.

[84]  M. Miravitlles,et al.  Diagnostic value of bronchoalveolar lavage in peripheral lung cancer. , 1993, The American review of respiratory disease.

[85]  M. Melamed,et al.  PULMONARY CYTOLOGY--A BRIEF SURVEY OF DIAGNOSTIC RESULTS FROM JULY 1ST 1952 UNTIL DECEMBER 31ST, 1960. , 1964, Acta cytologica.

[86]  P. Nath,et al.  Percutaneous needle biopsy of lung nodules following failed bronchoscopic biopsy. , 1992, European journal of radiology.

[87]  A. Böcking,et al.  Diagnosis of bronchial carcinoma on sections of paraffin-embedded sputum. Sensitivity and specificity of an alternative to routine cytology. , 1992, Acta cytologica.

[88]  T. Köse,et al.  CT Bronchus Sign-Guided Bronchoscopic Multiple Diagnostic Procedures in Carcinomatous Solitary Pulmonary Nodules and Masses , 1998, Respiration.

[89]  K. Thomson,et al.  Evaluation of a new transthoracic needle for biopsy of benign and malignant lung lesions. , 1977, AJR. American journal of roentgenology.

[90]  Bronchial brushing and biopsy: a comparative evaluation in diagnosing visible bronchial lesions. , 1990, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[91]  T. McLoud,et al.  Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. , 1996, AJR. American journal of roentgenology.

[92]  J. Meyer,et al.  Percutaneous aspiration biopsy of nodular lung lesions. , 1977, The Journal of thoracic and cardiovascular surgery.

[93]  D. Cortese,et al.  Transbronchoscopic Lung Biopsy for Localized Pulmonary Disease , 1981 .

[94]  W. Tsang,et al.  The importance of three-dimensional brachytherapy treatment planning for nasopharyngeal carcinoma. , 1997, Clinical oncology (Royal College of Radiologists (Great Britain)).

[95]  S. Hauptmann,et al.  Cytologic versus histologic evaluation of needle biopsy of the lung, hilum and mediastinum. Sensitivity, specificity and typing accuracy. , 1995, Acta cytologica.

[96]  Costrini Am.  Transthoracic needle aspiration biopsy of focal pulmonary lesions: a community hospital experience. , 1986 .

[97]  G. Salomon,et al.  Transthoracic needle biopsy with a coaxially placed 20-gauge automated cutting needle: results in 122 patients. , 1996, Radiology.

[98]  L. Ackerman,et al.  Exfoliative cytology and pulmonary cancer. , 1955, Acta - Unio Internationalis Contra Cancrum.

[99]  Zakowski Mf,et al.  Negative predictive value of pulmonary fine needle aspiration cytology. , 1992 .

[100]  W. Umiker.  Diagnosis of bronchogenic carcinoma: an evaluation of pulmonary cytology, bronchoscopy and scalene lymph node biopsy. , 1960, Diseases of the Chest.

[101]  R. Antic,et al.  Percutaneous aspiration biopsy of discrete lung lesions , 1974, Cancer.

[102]  W. Lam,et al.  Fibreoptic bronchoscopy in the diagnosis of bronchial cancer: comparison of washings, brushings and biopsies in central and peripheral tumours. , 1983, Clinical oncology.

[103]  Johnston Ww.  Percutaneous fine needle aspiration biopsy of the lung. A study of 1,015 patients. , 1984, Acta cytologica.

[104]  H. Pak,et al.  Rapid staining techniques employed in fine needle aspirations of the lung. , 1981, Acta cytologica.

[105]  P. Kvale,et al.  Diagnostic accuracy in lung cancer; comparison of techniques used in association with flexible fiberoptic bronchoscopy. , 1976, Chest.

[106]  H. Zwick,et al.  Diagnostic sensitivity of different techniques in the diagnosis of lung tumors with the flexible fiberoptic bronchoscope. Comparison of brush biopsy, imprint cytology of forceps biopsy, and histology of forceps biopsy , 1991, Cancer.

[107]  T. Vogl,et al.  CT‐GUIDED PERCUTANEOUS CORE BIOPSIES OF PULMONARY LESIONS , 2001 .

[108]  C. Kortsik,et al.  Comparison of the sensitivity of sputum and brush cytology in the diagnosis of lung carcinomas. , 1997, Acta cytologica.

[109]  R. Greene,et al.  Supplementary tissue-core histology from fine-needle transthoracic aspiration biopsy. , 1985, AJR. American journal of roentgenology.

[110]  F. Rilke,et al.  Fine needle aspiration biopsy cytology of primary and metastatic pulmonary tumors. , 1982, Acta cytologica.

[111]  F. Rilke,et al.  Sputum cytology for the diagnosis of carcinoma of the lung. , 1982, Acta cytologica.

[112]  J. H. Crosby,et al.  Transthoracic fine‐needle aspiration. Experience in a cancer center , 1985, Cancer.

[113]  W. Baaklini,et al.  Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. , 2000, Chest.

[114]  J. Da,et al.  Transthoracic needle aspiration biopsy. Review of 233 cases. , 1988, Acta cytologica.

[115]  E. Bossen,et al.  Ten years of respiratory cytopathology at Duke University Medical Center. I. The cytopathologic diagnosis of lung cancer during the years 1970 to 1974, noting the significance of specimen number and type. , 1981, Acta cytologica.

[116]  W. B. Allan,et al.  The results of the experimental use of sulfur dioxide in the production of material for cell studies in lung cancer. , 1960, Annals of internal medicine.

[117]  H. Nath,et al.  Can chest CT decrease the use of preoperative bronchoscopy in the evaluation of suspected bronchogenic carcinoma? , 1998, Chest.

[118]  N. Burki,et al.  Fiberoptic bronchoscopy. Comparison of procedures used in the diagnosis of lung cancer. , 1978, The Journal of thoracic and cardiovascular surgery.

[119]  Kern Wh.  The diagnostic accuracy of sputum and urine cytology. , 1988 .

[120]  A. Liebow,et al.  Cytological studies of sputum and bronchial secretions in the diagnosis of cancer of the lung , 1948, Cancer.

[121]  F. Stitik,et al.  The clinical assessment of selected patients with bronchogenic carcinoma. , 1975, Annals of Thoracic Surgery.

[122]  M. Pirozynski,et al.  Bronchoalveolar lavage in the diagnosis of peripheral, primary lung cancer. , 1992, Chest.

[123]  P. Solli,et al.  CT-guided transthoracic needle biopsy in the diagnosis of chest tumours. , 1997, The Journal of cardiovascular surgery.

[124]  L. Dodd,et al.  A prospective comparison of fiberoptic transbronchial needle aspiration and bronchial biopsy for bronchoscopically visible lung carcinoma , 1999, Cancer.

[125]  Gagneten Cb,et al.  Diagnosis of bronchogenic carcinoma through the cytologic examination of sputum, with special reference to tumor typing. , 1976 .

[126]  K. Suen,et al.  Reliability of percutaneous needle aspiration biopsy for diagnosis of bronchogenic carcinoma. , 1981, Cancer detection and prevention.

[127]  P. Manalo,et al.  Diagnosis of pulmonary masses by fine-needle aspiration. , 1988, American journal of surgery.

[128]  G. Esposito,et al.  [Cytodiagnosis of lung cancer]. , 1957, Archivio di chirurgia del torace.

[129]  M. Nasiell.  Diagnosis of lung cancer by aspiration biopsy and a comparison between this method and exfoliative cytology. , 1967, Acta cytologica.

[130]  Cytologic and histologic correlation in primary lung cancer. A study of 154 cases with resectable tumors. , 1985, Acta cytologica.

[131]  J. E. Stark,et al.  Diagnostic accuracy of cytology and biopsy in primary bronchial carcinoma. , 1979, Thorax.

[132]  Starukhina If.  Cytological diagnosis of lung cancer , 1983 .

[133]  C I Henschke,et al.  CT-guided transthoracic needle biopsy of small solitary pulmonary nodules. , 1997, Clinical imaging.

[134]  Ng Ab,et al.  Factors significant in the diagnostic accuracy of lung cytology in bronchial washing and sputum samples. II. Sputum samples. , 1983 .

[135]  E. King,et al.  Needle aspiration biopsy of the lung--technique and cytologic morphology. , 1967, Acta cytologica.

[136]  M. Matsuda,et al.  Early diagnosis of small peripheral lung cancer--cytologic diagnosis of very fresh cancer cells obtained by the TV-brushing technique. , 1971, Acta Cytologica.

[137]  R. Antic,et al.  Percutaneous biopsy of intrapulmonary mass lesions. Experience with a disposable cutting needle , 1983, Cancer.

[138]  S. Gasparini,et al.  Integration of TBNA and TCNA in the diagnosis of peripheral lung nodules. Influence on staging. , 1999, Annali italiani di chirurgia.

[139]  D. Geddes,et al.  Fibreoptic bronchoscopy: effect of multiple bronchial biopsies on diagnostic yield in bronchial carcinoma. , 1982, Thorax.

[140]  K. Torrington,et al.  The utility of fiberoptic bronchoscopy in the evaluation of the solitary pulmonary nodule. , 1993, Chest.

[141]  D A Schenk,et al.  Transbronchial needle aspiration in the diagnosis of bronchogenic carcinoma. , 1987, Chest.

[142]  W M Brutinel,et al.  Transbronchial needle aspiration in the practice of bronchoscopy. , 1989, Mayo Clinic proceedings.

[143]  R. R. Bentz,et al.  The effect of tumor size and location on diagnosis by fiberoptic bronchoscopy. , 1977, Chest.

[144]  Computed tomographic fluoroscopy-guided transthoracic needle biopsy for diagnosis of pulmonary nodules. , 2000, Japanese journal of clinical oncology.

[145]  W. Johnston,et al.  Percutaneous fine needle aspiration biopsy of the lung. A study of 1,015 patients. , 1984, Acta cytologica.

[146]  J. Benbassat,et al.  Predictive value of sputum cytology. , 1987, Thorax.

[147]  Risse Ek,et al.  Relationship between patient characteristics and the sputum cytologic diagnosis of lung cancer. , 1987 .