Bronchoalveolar Lavage in the Diagnosis of Peripheral Primary and Secondary Malignant Lung Tumors

Abstract

The success rate of cytological examination of the bronchoalveolar lavage fluid (BALF) in patients with primary or metastatic lung tumors varies considerably according to different authors. In a prospective study, we have tried to establish the sensitivity of BAL in comparison with both transbronchial lung biopsy (TBB) and brushing. BAL was performed in 61 patients with lung malignancies and in 56 patients with nonmalignant lung disease: 39 patients had primary lung cancer, 22 had metastatic spread into the lungs. First the part of the lung involved was washed out with 100 ml physiological saline solution during bronchoscopy. Following BAL, 5 TBB and brushing were performed. The smears were stained by the May-Grünwald-Giemsa method. Malignant cells were found in BALF from 17 patients, in TBB specimens from 43 and in brushing smears from 26. TBB was significantly the most successful method applied. Malignant cells were never found in BALF only, nor were they ever found in patients with non-malignant lung disease. The sensitivity of the three methods was equal for primary as compared to metastatic tumors and for interstitial infiltrates as compared to coin lesions. Malignant cells were most frequently found in centrifuged specimens. BAL may be used in suspected malignant interstitial or rounded pulmonary infiltrates when it cannot be reached by forceps or brush, or when TBB and brushing are contra-indicated.

Diagnostic yield of non‐guided flexible bronchoscopy for peripheral pulmonary neoplasia

“…In the present study, the overall sensitivity of bronchoscopy for the diagnosis of lung neoplasia not visible endoscopically was comparable to previous studies evaluating non‐guided conventional bronchoscopy without transbronchial biopsy (6–33%) . While some studies suggested a global sensitivity of 78% for bronchoscopy in the diagnosis of lung cancer, fluoroscopic guidance was used and transbronchial biopsies were performed in the vast majority of these studies. In addition, some of those series also included endobronchial lesions and benign lesions.…”

Cytopathologic differential diagnosis of small cell carcinoma and poorly differentiated non‐small cell carcinoma in bronchial lavage specimens using a regression analysis

“…The overall sensitivity and specificity of sputum and bronchial cytology are about 70–80%. Under optimum conditions, the sensitivity and specificity can be as high as 90% or even more (2, 5, 8).…”

“…The efficacy of the cytologic examination of bronchoalveolar lavage specimens in primary lung cancer has been proved. Bronchoalveolar lavage, an easily performed and well‐tolerated procedure, is considered useful in the routine assessment of patients for cancer (5–7). Moreover, about 75% of lung carcinomas are diagnosed cytologically (2).…”

Predictors of diagnostic yield in bronchoscopy: a retrospective cohort study comparing different combinations of sampling techniques

“…SVL and aspiration had lower diagnostic yields for visible and non visible lesions, compared with other studies [ 21 , 25 , 33 ]. Studies with bronchoalveolar lavage have had a higher diagnostic yield, possibly due to higher fluid volume [ 22 , 23 ]. The low diagnostic yield might also be explained by the procedure of taking a small sample of 10–20 ml from the fluid aspirated and the lack of wedging the bronchoscope into the affected bronchus.…”

“…Previous studies of bronchoscopy in peripheral lesions have shown a great variability in the diagnostic yield, with sensitivity for cancer between 20% and 86% [ 5 - 9 ]. The reported predictors of positive samples have been size [ 6 , 9 - 16 ], location [ 10 , 13 , 14 , 17 ], visible lesion, compression or constriction [ 12 , 18 , 19 ], CT bronchus sign [ 13 , 17 , 20 ], fuzzy or sharp border [ 11 ], the use of a C-arm fluoroscope [ 8 , 21 ], and sampling technique [ 11 , 14 , 15 , 18 , 22 - 29 ]. Many studies were based on bronchoscopies performed by selected investigators in highly specialized centres [ 5 , 8 , 10 , 18 ].…”