Real-world study of lung cytology in the diagnostic workflow of lung cancer

In the era of precision oncology, lung cancer diagnosis still relies on small and often limited tissue samples, which may be insufficient for definitive tumor classification and predictive biomarker assessment. In this context, lung cytology is gaining increased attention as a complementary source of tumor cells. A retrospective analysis of patients diagnosed with lung cancer who uderwent cytological sampling at the University Hospital of Salerno (Italy) between 2022 and 2025 evaluated the real-world diagnostic contribution of lung cytology in routine clinical practice. Cases without histological biopsy were included when cytology represented the only clinical accepted diagnostic material. A total of 572 patients with 691 cytological specimens were included. Cytology provided an important diagnostic contribution in 121 cases (21.2%), providing primary diagnosis in 99 cases (17.3%, and enabling predictive biomarker assessment in 22 cases (3.8%). A supportive role, defined as cytological findings concordant with histological results, was observed in additional 250 cases (43.7%), bringing the overall proportion of cases in which cytology provided any diagnostic contribution to 64.9%. Diagnostic and predictive performanced varied significantly according to specimen type: pleural effusions and conventional transbronchial needle aspirations showed significantly higher adequacy for molecular testing compared with bronchial aspirates (p<0.0001). In patients with multiple cytological samples, the integration of different sampling techniques significantly reduced non-diagnostic cases (p<0.001). The authors conclude that cytological samples provided and independent diagnostic and predictive contribution in more than 20% of cases and supported histological findings in a further 43% of patients.xtagstartz/p>