Background To increase the diagnostic yield in pulmonary diseases, histopathology, imprint cytology and brushing cytology are assessed in combination during flexible bronchoscopy. However, the individual diagnostic discrimination of the three methods is unclear.

Methods The authors performed the three sampling techniques in 102 consecutive patients with suspected pulmonary pathologies and compared the definitive diagnosis with those of histopathology, imprint and brushing cytology for their diagnostic values regarding evidence of malignancy.

Results 33.3% of all histopathological specimens, 31.4% of all imprints and 26.5% of brush biopsy specimens were positive for malignancy. The values for sensitivities were 94% for histopathology, 89% for imprint cytology and 75% for brushing cytology, respectively. Although brushing cytology had limited sensitivity, in two cases a malignant lung tumour was only diagnosed from cytological examination of brushing.

Conclusion In conclusion, routine imprint cytology does not increase the diagnostic sensitivity, whereas routine brushing cytology should be used in combination with histopathology to obtain the highest diagnostic rate of yield.