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After the correspondence of Burton and colleagues1 and the Royal College of Pathologists’ working group guidelines2 on the use of sputum cytology as a diagnostic test, we reviewed sputum figures for our department for the period 1998–2001. The results are shown in table 1. These figures confirm that a high proportion of samples are unsatisfactory (30%), although our diagnostic rate (8%) for malignancy was higher than that of Burton et al,1 who identified only a solitary carcinoma. In addition, although most of the unsatisfactory specimens were submitted by non-respiratory physicians, it was this group that yielded the high pick up rate of malignancy (73%). We consider from these results that sputum cytology still has a place in the investigation of patients with suspected lung malignancy who are unsuitable for bronchoscopy. We agree however that careful selection of patients and correct collection of adequate lower tract material are essential. Although sputum sampling is thought of as a relatively quick, easy, and cheap investigation, it is labour intensive for pathology laboratory and medical staff to prepare and examine. In this present climate of pathology staff shortage, we agree that the use of this test should be restricted.
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