Cytologic Diagnosis in Bronchoalveolar Lavage Specimens: A Diagnostic Technique for Lung Neoplasmas with a Peripheral Location

Abstract

To the EditorThe analysis of BAL (bronchoalveolar lavage) cytologic specimens has been found diagnostically useful in primary lung lymphoma1Davis WB Gadek JE. Detection of pulmonary lymphoma by bronchoalveolar lavage.Chest. 1987; 91: 787-790Crossref PubMed Scopus (40) Google Scholar, 2Weynants P Cordier JF Cellier CC Pages J Loire R Brune J. Primary immunocytoma of the lung: the diagnostic value of bronchoalveolar lavage.Thorax. 1985; 40: 542-543Crossref PubMed Scopus (24) Google Scholar and in the diagnosis of parenchymal lung involvement in Hodgkin’s disease3Morales FM Matthews JI. Diagnosis of parenchymal Hodgkin’s disease using bronchoalveolar lavage.Chest. 1987; 91: 785-787Crossref PubMed Scopus (18) Google Scholar and mycosis fungoides.4Miller KS Sahn SA. Mycosis fungoides presenting as ARDS and diagnosed by bronchoalveolar lavage. Radiographic and pathologic pulmonary manifestations.Chest. 1986; 89: 312-314Abstract Full Text Full Text PDF PubMed Google Scholar Few workers have analysed the diagnostic sensitivity in peripheral lung carcinoma. The sensitivity achieved in peripheral lesions that cannot be visualized through the bronchoscope has been 60 percent in one report5Zavadilova H. Comparison of sputum and bronchoalveolar lavage examination in patients with cancer. Eleventh European Congress of Cytology, 1982: 171Google Scholar and 35 percent in another study.6Sineway MJ Francis PB Honig EG Boozer RM Nassar VH. Bronchoalveolar lavage in the diagnosis of peripheral lung cancer.Am Rev Respir Dis. 1984; 129: 68Crossref Google Scholar We have tried to determine if the diagnostic yield of the bronchial washing and post-bronchoscopy sputum was increased by the addition of BAL cytologic analysis in a group of 30 patients with primary lung carcinoma in whom the endobronchial lesion could not be visualized through the bronchoscope. Twenty-six patients were men and four women, mean age was 45 years with a range of 36 to 75 years. All had a Karnofsky’s index7Karnofsky DA Burchenal JH McLeod A Evaluation of chemotherapeutic agents. Columbia University Press, New York1949Google Scholar exceeding 80 percent. Radiologically, 26 patients showed a peripherically-located node or mass and four had an infiltrative pattern of involvement. Eleven had epidermoid carcinomas, 11 adenocarcinomas, six small cell and two with mixed histology. The analysis of BAL specimens revealed malignant cells in eight patients (26 percent), while bronchial washing was positive in 12 patients (40 percent). In the remaining 14 patients, the diagnosis was reached by complementary techniques or by surgery. The diagnostic sensitivity, with the combined use of bronchial washings and post-bronchoscopy sputum, was 40 percent. Since in four patients the diagnosis of malignancy was reached exclusively by analysis of BAL specimens, analysis with all three procedures obtains an overall sensitivity of 53 percent. The addition of BAL does not significantly increases diagnostic sensitivity obtained with the combined use of bronchial washing plus post-bronchoscopy sputum (p>0.05).Because of the small number of patients, we did not find differences in BAL positivities in relation to histologic diagnosis. In contrast, it is interesting that three of four patients with infiltrative patterns were positive on BAL analysis, and two of them positive exclusively by this diagnostic method. By contrast, only five of 26 patients with nodular radiologic lesions had a positive diagnostic test. Our results are similar to those reported by Sineway et al.6Sineway MJ Francis PB Honig EG Boozer RM Nassar VH. Bronchoalveolar lavage in the diagnosis of peripheral lung cancer.Am Rev Respir Dis. 1984; 129: 68Crossref Google Scholar Baglin and coworkers6Sineway MJ Francis PB Honig EG Boozer RM Nassar VH. Bronchoalveolar lavage in the diagnosis of peripheral lung cancer.Am Rev Respir Dis. 1984; 129: 68Crossref Google Scholar found neoplastic cell in nine of 11 BAL specimens from patients with lung cancer and diffuse infiltrative patterns. This method seems also to be helpful for the diagnosis of bronchoalveolar carcinoma.9Springmeyer SC Hackman R Carlson JJ McClellan JE. Bronchioloalveolar carcinoma diagnosed by bronchoalveolar lavage.Chest. 1983; 83: 278-279Crossref PubMed Scopus (23) Google ScholarWe concluded that the addition of BAL cytologic examinations in peripheral lung lesions might occasionally increase the diagnostic yield of bronchoscopy and spare some patients unnecessary invasive procedures.10Turner-Warwick ME Haslam PL. Clinical applications of bronchoalveolar lavage: an interim view.Br J Dis Chest. 1986; 80: 105-121Abstract Full Text PDF PubMed Scopus (18) Google Scholar, 11Bellmunt J. Bronchoalveolar lavage in smokers and in lung cancer (thesis). Universidad Autonoma de Barcelona, 1989Google Scholar This diagnostic technique seems especially indicated in lung cancer with an infiltrative x-ray pattern. To the EditorThe analysis of BAL (bronchoalveolar lavage) cytologic specimens has been found diagnostically useful in primary lung lymphoma1Davis WB Gadek JE. Detection of pulmonary lymphoma by bronchoalveolar lavage.Chest. 1987; 91: 787-790Crossref PubMed Scopus (40) Google Scholar, 2Weynants P Cordier JF Cellier CC Pages J Loire R Brune J. Primary immunocytoma of the lung: the diagnostic value of bronchoalveolar lavage.Thorax. 1985; 40: 542-543Crossref PubMed Scopus (24) Google Scholar and in the diagnosis of parenchymal lung involvement in Hodgkin’s disease3Morales FM Matthews JI. Diagnosis of parenchymal Hodgkin’s disease using bronchoalveolar lavage.Chest. 1987; 91: 785-787Crossref PubMed Scopus (18) Google Scholar and mycosis fungoides.4Miller KS Sahn SA. Mycosis fungoides presenting as ARDS and diagnosed by bronchoalveolar lavage. Radiographic and pathologic pulmonary manifestations.Chest. 1986; 89: 312-314Abstract Full Text Full Text PDF PubMed Google Scholar Few workers have analysed the diagnostic sensitivity in peripheral lung carcinoma. The sensitivity achieved in peripheral lesions that cannot be visualized through the bronchoscope has been 60 percent in one report5Zavadilova H. Comparison of sputum and bronchoalveolar lavage examination in patients with cancer. Eleventh European Congress of Cytology, 1982: 171Google Scholar and 35 percent in another study.6Sineway MJ Francis PB Honig EG Boozer RM Nassar VH. Bronchoalveolar lavage in the diagnosis of peripheral lung cancer.Am Rev Respir Dis. 1984; 129: 68Crossref Google Scholar We have tried to determine if the diagnostic yield of the bronchial washing and post-bronchoscopy sputum was increased by the addition of BAL cytologic analysis in a group of 30 patients with primary lung carcinoma in whom the endobronchial lesion could not be visualized through the bronchoscope. Twenty-six patients were men and four women, mean age was 45 years with a range of 36 to 75 years. All had a Karnofsky’s index7Karnofsky DA Burchenal JH McLeod A Evaluation of chemotherapeutic agents. Columbia University Press, New York1949Google Scholar exceeding 80 percent. Radiologically, 26 patients showed a peripherically-located node or mass and four had an infiltrative pattern of involvement. Eleven had epidermoid carcinomas, 11 adenocarcinomas, six small cell and two with mixed histology. The analysis of BAL specimens revealed malignant cells in eight patients (26 percent), while bronchial washing was positive in 12 patients (40 percent). In the remaining 14 patients, the diagnosis was reached by complementary techniques or by surgery. The diagnostic sensitivity, with the combined use of bronchial washings and post-bronchoscopy sputum, was 40 percent. Since in four patients the diagnosis of malignancy was reached exclusively by analysis of BAL specimens, analysis with all three procedures obtains an overall sensitivity of 53 percent. The addition of BAL does not significantly increases diagnostic sensitivity obtained with the combined use of bronchial washing plus post-bronchoscopy sputum (p>0.05).Because of the small number of patients, we did not find differences in BAL positivities in relation to histologic diagnosis. In contrast, it is interesting that three of four patients with infiltrative patterns were positive on BAL analysis, and two of them positive exclusively by this diagnostic method. By contrast, only five of 26 patients with nodular radiologic lesions had a positive diagnostic test. Our results are similar to those reported by Sineway et al.6Sineway MJ Francis PB Honig EG Boozer RM Nassar VH. Bronchoalveolar lavage in the diagnosis of peripheral lung cancer.Am Rev Respir Dis. 1984; 129: 68Crossref Google Scholar Baglin and coworkers6Sineway MJ Francis PB Honig EG Boozer RM Nassar VH. Bronchoalveolar lavage in the diagnosis of peripheral lung cancer.Am Rev Respir Dis. 1984; 129: 68Crossref Google Scholar found neoplastic cell in nine of 11 BAL specimens from patients with lung cancer and diffuse infiltrative patterns. This method seems also to be helpful for the diagnosis of bronchoalveolar carcinoma.9Springmeyer SC Hackman R Carlson JJ McClellan JE. Bronchioloalveolar carcinoma diagnosed by bronchoalveolar lavage.Chest. 1983; 83: 278-279Crossref PubMed Scopus (23) Google ScholarWe concluded that the addition of BAL cytologic examinations in peripheral lung lesions might occasionally increase the diagnostic yield of bronchoscopy and spare some patients unnecessary invasive procedures.10Turner-Warwick ME Haslam PL. Clinical applications of bronchoalveolar lavage: an interim view.Br J Dis Chest. 1986; 80: 105-121Abstract Full Text PDF PubMed Scopus (18) Google Scholar, 11Bellmunt J. Bronchoalveolar lavage in smokers and in lung cancer (thesis). Universidad Autonoma de Barcelona, 1989Google Scholar This diagnostic technique seems especially indicated in lung cancer with an infiltrative x-ray pattern. The analysis of BAL (bronchoalveolar lavage) cytologic specimens has been found diagnostically useful in primary lung lymphoma1Davis WB Gadek JE. Detection of pulmonary lymphoma by bronchoalveolar lavage.Chest. 1987; 91: 787-790Crossref PubMed Scopus (40) Google Scholar, 2Weynants P Cordier JF Cellier CC Pages J Loire R Brune J. Primary immunocytoma of the lung: the diagnostic value of bronchoalveolar lavage.Thorax. 1985; 40: 542-543Crossref PubMed Scopus (24) Google Scholar and in the diagnosis of parenchymal lung involvement in Hodgkin’s disease3Morales FM Matthews JI. Diagnosis of parenchymal Hodgkin’s disease using bronchoalveolar lavage.Chest. 1987; 91: 785-787Crossref PubMed Scopus (18) Google Scholar and mycosis fungoides.4Miller KS Sahn SA. Mycosis fungoides presenting as ARDS and diagnosed by bronchoalveolar lavage. Radiographic and pathologic pulmonary manifestations.Chest. 1986; 89: 312-314Abstract Full Text Full Text PDF PubMed Google Scholar Few workers have analysed the diagnostic sensitivity in peripheral lung carcinoma. The sensitivity achieved in peripheral lesions that cannot be visualized through the bronchoscope has been 60 percent in one report5Zavadilova H. Comparison of sputum and bronchoalveolar lavage examination in patients with cancer. Eleventh European Congress of Cytology, 1982: 171Google Scholar and 35 percent in another study.6Sineway MJ Francis PB Honig EG Boozer RM Nassar VH. Bronchoalveolar lavage in the diagnosis of peripheral lung cancer.Am Rev Respir Dis. 1984; 129: 68Crossref Google Scholar We have tried to determine if the diagnostic yield of the bronchial washing and post-bronchoscopy sputum was increased by the addition of BAL cytologic analysis in a group of 30 patients with primary lung carcinoma in whom the endobronchial lesion could not be visualized through the bronchoscope. Twenty-six patients were men and four women, mean age was 45 years with a range of 36 to 75 years. All had a Karnofsky’s index7Karnofsky DA Burchenal JH McLeod A Evaluation of chemotherapeutic agents. Columbia University Press, New York1949Google Scholar exceeding 80 percent. Radiologically, 26 patients showed a peripherically-located node or mass and four had an infiltrative pattern of involvement. Eleven had epidermoid carcinomas, 11 adenocarcinomas, six small cell and two with mixed histology. The analysis of BAL specimens revealed malignant cells in eight patients (26 percent), while bronchial washing was positive in 12 patients (40 percent). In the remaining 14 patients, the diagnosis was reached by complementary techniques or by surgery. The diagnostic sensitivity, with the combined use of bronchial washings and post-bronchoscopy sputum, was 40 percent. Since in four patients the diagnosis of malignancy was reached exclusively by analysis of BAL specimens, analysis with all three procedures obtains an overall sensitivity of 53 percent. The addition of BAL does not significantly increases diagnostic sensitivity obtained with the combined use of bronchial washing plus post-bronchoscopy sputum (p>0.05). Because of the small number of patients, we did not find differences in BAL positivities in relation to histologic diagnosis. In contrast, it is interesting that three of four patients with infiltrative patterns were positive on BAL analysis, and two of them positive exclusively by this diagnostic method. By contrast, only five of 26 patients with nodular radiologic lesions had a positive diagnostic test. Our results are similar to those reported by Sineway et al.6Sineway MJ Francis PB Honig EG Boozer RM Nassar VH. Bronchoalveolar lavage in the diagnosis of peripheral lung cancer.Am Rev Respir Dis. 1984; 129: 68Crossref Google Scholar Baglin and coworkers6Sineway MJ Francis PB Honig EG Boozer RM Nassar VH. Bronchoalveolar lavage in the diagnosis of peripheral lung cancer.Am Rev Respir Dis. 1984; 129: 68Crossref Google Scholar found neoplastic cell in nine of 11 BAL specimens from patients with lung cancer and diffuse infiltrative patterns. This method seems also to be helpful for the diagnosis of bronchoalveolar carcinoma.9Springmeyer SC Hackman R Carlson JJ McClellan JE. Bronchioloalveolar carcinoma diagnosed by bronchoalveolar lavage.Chest. 1983; 83: 278-279Crossref PubMed Scopus (23) Google Scholar We concluded that the addition of BAL cytologic examinations in peripheral lung lesions might occasionally increase the diagnostic yield of bronchoscopy and spare some patients unnecessary invasive procedures.10Turner-Warwick ME Haslam PL. Clinical applications of bronchoalveolar lavage: an interim view.Br J Dis Chest. 1986; 80: 105-121Abstract Full Text PDF PubMed Scopus (18) Google Scholar, 11Bellmunt J. Bronchoalveolar lavage in smokers and in lung cancer (thesis). Universidad Autonoma de Barcelona, 1989Google Scholar This diagnostic technique seems especially indicated in lung cancer with an infiltrative x-ray pattern.