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Dual cervical parasitosis in a psychiatric patient

laboratory of each additional diagnostic test was found to be £425. The approximate cost to the hospital of each additional positive diagnosis was £1380 (see Table 2). We found a marginal advantage from the combination of washings and biopsy, as opposed to brushings and biopsy, but there was a significant difference in the number of cases where the cytology provided corroborative evidence to the histology, with washings more often supporting the biopsy than brushings. The correlation of cytology and histology results is a useful means of quality control. What would have been the effect on patient care if brushings had been omitted during the period of our study? We would have reported two false negatives during the 2-year period. In one case a tumour was seen bronchoscopically; in the other a tumour was seen on X-ray in a smoker with clubbing. In both cases the patient would have been further investigated and appropriately managed despite the false-negative histology/cytology. One of our bronchoscopists already omits brushings if a good biopsy has been obtained. There is now quantitative evidence to support this, at least in this hospital, using our methods of collection and processing. Given the wide variation in bronchoscopic and laboratory practice between different hospitals, it may be appropriate for each laboratory/bronchoscopy unit to conduct its own audit of the cost-effectiveness of this and other tests.