Evaluation of Bronchoalveolar Lavage Cytology (B.A.L) in the Diagnosis of Lung Cancer among Sudanese Patients in Khartoum State Hospitals

Abstract

Introduction: Lung cancer is the most common cause of cancer mortality worldwide, causing approximately 1.2 million deaths per year. Bronchoalveolar Lavage (BAL) is a minimally invasive procedure that has gained acceptance and steady popularity as a tool for diagnosing lung cancer. The aim of this study was to compare the diagnostic efficacy of BAL in diagnosing lung cancer, taking bronchial biopsy as the ‘Gold Standard’ diagnostic test. Material and Methods: During the period from 2010 to 2012, 179 BAL cytology samples were prepared for cytology examination and smears were stained with Diff Quick stain. Bronchial biopsy histological sections were stained with H&E stain. Histo/Cytology correlation was performed in 83 cases to determine the sensitivity and specificity of BAL in diagnosis of lung carcinoma. Results: Out of the 179 cases, 118 (65.9%) were males and 61 (34.1%) were females. The ages ranged from 18 to 86 years old. BAL cytology cases reported with diagnoses of negative for malignant cells (nZ152, 84.9%), suspicious (nZ12, 6.7%), and carcinoma (nZ15, 8.4%). Bronchial biopsy specimens showed benign and malignant conditions in 69 (76.6%), and 21 (23.4%) respectively. Of the 21 malignant conditions, 11 were squamous cell carcinoma, 9 were adenocarcinoma, and one case was small cell carcinoma. The correlation between BAL cytology and histology results were performed in 83 cases. BAL sensitivity and specificity was 55%, and 95% respectively. Conclusion: Bronchoalveolar Lavage (BAL) is an easily performed, noninvasive, and well tolerated procedure that is useful in routine assessment of patients for lung carcinoma. The low sensitivity of BAL in our study stresses the importance of optimum sampling as well as cytopreperatory techniques using cyto-centrifugation. BAL combined to bronchial biopsy increases the accuracy of lung carcinoma diagnosis.