Diagnosis of cancer of the lung by the cytologic method.

The application of the fixation and staining technique developed by one of us (Papanicolaou)’.2 in the study of sputum for cancer cells was first used by us June 22, 1945. The material was procured from a patient whose symptoms were those of a man who was discharged from the United States Navy in April 1945 as a psychoneurotic. His routine chest plate was reported as negative. He had a chronic, so-called “tobacco” cough, anorexia, insomnia, restlessness, nervousness and weight loss. On June 5th, 1945 he coughed up a small quantity of blood and a chest x-ray examination revealed an infiltrative lesion in the right upper lobe with nodes along the right mediastinal border. Bronchoscopy and bronchial washings were negative. Sputum smears showed typical cancer cells. Subsequent exploratory operation revealed an Inoperable bronchogenic carcinoma (Figures 1, 2 and 3). Since the above date, over 1,300 cases have been studied. The specimens were procured primarily from patients of the New York Hospital and the Memorial Hospital. A monograph is now under preparation in which a description of the cystologic findings and a statistical analysis of the diagnostic accuracy of this method will be given. In a tabulation of 298 cases already reported in the American Journal of Public Health,3 the accuracy was approximately 95 per cent for the positive reports (Classes IV and V) t and 85 per cent for the negative (Classes I and II). Of the cases reported as suspicious (Class III), approximately 50 per cent proved subsequently to be positive.