MULTIPLE BRUSHINGS WITH IMMEDIATE RIUS STAIN VIA FLEXIBLE FIBEROPTIC BRONCHOSCOPY WITHOUT FLUOROSCOPIC GUIDANCE IN THE DIAGNOSIS OF PERIPHERAL PULMONARY TUMORS

Background - Accurate diagnosis of peripheral pulmonary lesions usuall y relies on fluoroscopic guided procedures. As fluoroscopy is not rout inely available in many respiratory units, an approach not using fluor oscopy but with a high diagnostic yield is highly desirable. Methods - Immediate cytological examination of multiple brushings using Riu's s tain, a modified Wright's stain, was performed in 38 patients with per ipheral pulmonary lesions not visible at bronchoscopy. The results wer e compared with the final diagnoses determined by histological examina tion or subsequent Papanicolaou staining of cytological specimens and clinical. course. Results - Of the 38 patients 29 were subsequently co nfirmed to have a malignant tumour. Our method provided a diagnosis of malignancy in 86% of these lesions. The accuracy (91%) and sensitivit y (88%) were higher for lesions >3 cm in diameter than for those of di ameter less than or equal to 3 cm (87% and 83%). There were no false p ositive results. The 29 lesions correctly diagnosed as malignant by Ri u's stain required significantly fewer brushings (mean (SD) 3 (2)) tha n the nine benign lesions (5 (4)). Conclusions - This technique provid es a high diagnostic yield, avoids the need for fluoroscopy, and is pr obably safer than percutaneous biopsy.