The contribution of bronchoalveolar lavage performed before and after bronchoscopic biopsies to the diagnosis of peripheral lung cancer

Abstract

The sensitivity of all fiberoptic bronchoscopic techniques in case of a peripheral lung cancer is 69%. In the study, it was aimed to assess the contribution of broncoalveolar lavage (BAL) performed before and after standard biopsy procedures in the diagnosis of peripheral lung cancer. The patients with peripheral lung lesion in radiology, and normal bronchoscopic findings were included in the study, prospectively. BAL was performed in all patients additionally standard biopsy procedures (forceps biopsy, bronchial brushing, trans bronchial forceps biopsy, trans bronchial needle aspiration). BAL was performed prior (BAL 1) and after (BAL 2) other biopsies. Thirty male with a mean age of 61.9 years were included. In radiology, 26 patients had peripheral-located node or mass and four had an infiltrative pattern of involvement. The cytology/histopathology was adenocarcinoma in 12, non-small cell carcinoma in 9, squamous cell carcinoma in 7 and small cell carcinoma in 2. The cytology of BAL was positive in 6 (20%). The diagnosis was made by cytology of BAL alone in 1, by standard biopsy procedures in 19, and by trans thoracic needle aspiration in 10. The diagnostic yield, with the combined use of BAL and standard biopsies was 66%. The difference of diagnostic yield between BAL 1 (13.3%) and BAL 2 (20%) was significant (p= 0.003). The addition of cytology of bronchoalveolar lavage in peripheral lung cancer may increase the diagnostic yield of bronchoscopy and spare some patients from unnecessary invasive procedures. The BAL performed after other biopsy procedures have a significant additive effect on diagnosis.