Shifted focus of bronchoalveolar lavage in patients with suspected thoracic malignancy: An analysis of 224 patients

Xin Zhang, Yukun Kuang, Yuan Zhang, Kai He, Noah Lechtzin, Mingying Zeng, Rex C. Yung, Canmao Xie

Research output: Contribution to journalArticle

Abstract

Background: Bronchoscopies are extensively adopted for diagnosing and staging thoracic malignancies, but studies are missing as how to keep the process streamlined and more efficient. To evaluate current role of bronchoalveolar lavage (BAL) for cancer and possible infection diagnosis when practicing comprehensive bronchoscopy for patients suspected with thoracic malignancy, and provide foundation for possible practice modification. Methods: We retrospectively analyzed a prospectively kept database of immunocompetent patients undergoing bronchoscopy for suspected non-hematologic malignancies. Clinical, radiographic data, bronchoscopic sampling techniques and diagnostic results were recorded. Initially undiagnostic patients were followed up for 2 years for a definitive diagnosis. Results: Of 224 patients included, 179 (79.9%) were confirmed with active thoracic malignancies. BAL diagnostic yield of cancer based on different radiographic characters of target lesion are as follow: isolated lymphadenopathies 0%, central lesions 45.5%, peripheral masses (diameter ≥3 cm) 21.4%, peripheral large nodules (2≤ diameter <3 cm) 15.8%, and peripheral small nodules (diameter <2 cm) 7.1%, while composite bronchoscopy achieved diagnostic yield of 93.3%, 95.5%, 91.7%, 76.9%, and 66.7% in corresponding lesion types. No cancer was diagnosed solely by BAL-cytology. Proportions of patients with positive BAL culture did not differ significantly between patients with and without pre-test suspicion for infections (P=0.199). In multivariable analysis, infections were associated with age ≥75 (OR 3.0; 95% CI: 1.29-7.06), chronic obstructive pulmonary disease (COPD) (OR 2.7; 95% CI: 1.14-6.26) and diabetes mellitus (DM) (OR 4.5; 95% CI: 1.90-10.44). Conclusions: Omitting BAL cytology in settings of comprehensive bronchoscopy may not compromise cancer diagnosis. For patients primarily suspected with thoracic malignancy, performing BAL culture only based on clinical suspicion could miss important infectious etiology.

Original languageEnglish (US)
Pages (from-to)3245-3254
Number of pages10
JournalJournal of Thoracic Disease
Volume8
Issue number11
DOIs
StatePublished - 2016

Keywords

  • Bronchoalveolar lavage (BAL)
  • Bronchoscopy
  • Lower respiratory tract infections (LRTIs)
  • Peripheral lung lesion
  • Thoracic malignancies

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Fingerprint Dive into the research topics of 'Shifted focus of bronchoalveolar lavage in patients with suspected thoracic malignancy: An analysis of 224 patients'. Together they form a unique fingerprint.

  • Cite this