Pulmonary Cytology

  • Derek B. Allison
  • Qing Kay LiEmail author
Part of the Atlas of Anatomic Pathology book series (AAP)


The diagnostic sensitivity and specificity of pulmonary cytology have significantly improved over the past decade, mainly due to the advancement of sampling techniques and our increasing understanding of lung lesions. Both nonneoplastic and neoplastic pulmonary lesions make up many heterogeneous groups of diseases, many of which contain multiple histomorphological subtypes that are important for clinical management. Furthermore, the clinical and radiological presentations of many localized nonneoplastic lung lesions mimic malignant neoplasms. In these circumstances, an accurate diagnosis by tissue sampling is required for appropriate clinical management. In addition, recent large-scale genomic studies from the Clinical Lung Cancer Genome Project have identified actionable driver gene mutations in subtypes of non-small-cell lung carcinoma (NSCLC). These findings not only have led to remarkable progress in targeted therapies for lung cancer patients but also have provided missing fundamental knowledge for the accurate subclassification of NSCLC. In fact, in 2015, the World Health Organization (WHO) and the International Association for the Study of Lung Cancer (IASLC) updated their guidelines to reflect this progress. More recently, the advancement and clinical application of immunotherapy for patients with NSCLC have reinforced the need for accurate histologic subclassification. The WHO, recognizing the difficulty of evaluating cytological samples for the classification of NSCLC (in comparison to resected tumor tissue), has recommended specific criteria for cytological specimens. This chapter summarizes the cytological features of benign and malignant lung lesions and discusses the current WHO guidelines for the classification of lung cancer and the utility of immunomarkers in the diagnosis of lung lesions.


Pulmonary cytology Benign lung diseases Reactive bronchial epithelial changes Non-small-cell lung carcinoma NSCLC Small-cell lung carcinoma SCLC Transbronchial fine needle aspiration TBNA 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PathologyThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  2. 2.Department of Pathology and OncologyThe Johns Hopkins Medical InstitutionsBaltimoreUSA

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