LOCALIZATION OF DOUBLE, ROENTGENOGRAPHICALLY OCCULT LUNG-CANCER - CYTOLOGIC FINDINGS FROM SELECTIVE BRUSHING OF ALL SEGMENTAL AND SUBSEGMENTAL BRONCHI

Using selective brushing of all segmental and subsegmental bronchi, si x patients were diagnosed as having synchronous, double, roentgenograp hically occult lung cancers. Experienced bronchoscopists failed to det ect four ''second cancer'' lesions in six patients. Tire appearance of atypical cells as shown by cytologic examination indicated the probab ility of the presence of cancer in the examined bronchus. Single cance r cells or tiny clusters of cells with orangeophilic cytoplasm can app ear in specimens obtained from all bronchi, and such cells should not be considered to have originated in the bronchi under examination. Med ium-sized or large clusters of cancer cells without degeneration and w ith basophilic cytoplasm appear only in specimens obtained from bronch i in which a cancer lesion exists, and thus they should be considered to have originated in the bronchi under examination. Cancer cells with orangeophilic cytoplasm in clusters should be considered to have orig inated in unknown locations. To determine the origin of such cells, on e must compare the specimens with those obtained from other segmental and subsegmental bronchi. Our findings suggest that selective brushing of all segmental and subsegmental bronchi is a uselful method of dete cting unrecognizable second cancers and that the method should be empl oyed for all patients with positive sputum cytology.