Diagnostic value of bronchoalveolar lavage in peripheral lung cancer

ABSTRACT

The purpose of this study was to assess the value of the addition of bronchoalveolar lavage [BAL] to the routine bmnchoscopic exploration with bronchial washing [BW] and postbronchoscopy sputum [PBS] procedures in the diagnosis of peripheral primary lung cancer not visible through bronchoscope when fluoroscopic guidance is not available. BAL, BW, and PBS were performed in 40 patients with suspected primary lung cancer by peripheral lung lesion on chest radiograph and CT [24 nodules and 16 infiltrates]. Transthoracic percutaneous CT guided needle biopsy was performed in cases with negative bronchoscopic results Thirty two patients were found to have malignant disease [14 adenocarcnoma 12 squamous cell carcinoma, 4 small cell carcinoma and two bronchoalveolar cell caminoma]. BAL was positive in 11 of the 32 [34%] carcinomas and it gave the only positive results in four cases [12%].BW was also positive in 11 of the 32 [34%], but it gave positive results in only 2 [6%].PBS was positive in 11 of the 32 [34%] and gave the only positive results in one [3%]. The combination of cytologic study of the three samples produced a significantly greater number of diagnosis [15 of 32, 57%] than each procedure alone [P <0.02]. The diagnostic sensitivity was higher for infiltrates [8 of 12, 66%] than for nodular lesion [10 of 20, 50%]without regard to histologic cell type [P=0.035] of 8 patients with non malignant diseases [four pulmonary tuberculosis and four other benign diseases]. BAL was diagnostic in three of four patients with pulmonary tuberculosis and it gave the only positive results in two. In short, in the diagnosis of lung cancer presenting as a peripheral nodule or infiltrate, when fluoroscopic guidance is not available, at least a 50% yield can be obtained from cytologic examination BAL, aspiration of all bronchoscopic secretions before and after BAL and 3 days collection of early morning sputum after bronchoscopy. Additional advantages are its low morbidity and the high diagnostic value in other diseases such as pulmonary tuberculosis