Significance of Positive Bronchial Cytology in Presence of Squamous Cell Carcinoma of Upper Aerodigestive Tract

Abstract

The otolaryngologic literature reflects the high incidence of second primary neoplasms found in patients with a squamous cell carcinoma of the upper aerodigestive tract. Most commonly the second tumor is bronchogenic in origin. Routine panendoscopy (direct laryngoscopy, bronchoscopy, esophagoscopy) has been recommended in patients presenting with a squamous cell carcinoma primary in the upper aerodigestive tract. We have questioned the usefulness of obtaining bronchial washings during bronchoscopy in a patient who has an established primary in the upper aerodigestive tract. Perhaps false-positives would occur due to desquamation of tumor cells into the tracheobronchial tree. The authors address the incidence of false-positive washings encountered in a prospective evaluation of bronchial cytology encountered in 100 consecutive patients with primary squamous cell carcinoma of the upper aerodigestive tract who do not have primary bronchogenic carcinoma. A single false-positive (1 %) was encountered. It is concluded that epithelial carcinoma of the larynx and upper aerodigestive tract rarely shed identifiable tumor cells into the tracheobronchial tree. When malignant cells are found with bronchial washings, every effort should be made to localize a second primary tumor in the lung.