Prospective Study of Combined Use of Bronchial Lavages and Brushings in Diagnosis and Typing of Centrally Located Lung Tumors

Kakha Vacharadze**, Georgi Burkadze*, Gulisa Turashvili*

Objective: To determine the diagnostic accuracy of examining bronchial lavage (BAL) and brushing in pulmonary cytopathology and whether BAL and brushing can complement each other in routine practice among lung specialists. Design: A prospective study comparing 528 BAL and brushing results, conducted during 1999-2003. Tumors were confirmed by cytopathology, imaging techniques, or clinical outcome and imaging techniques combined. Subjects: 528 patients (374 men; 154 women) aged 65,3 years that underwent fibreoptic bronchoscopy for various pulmonary symptoms. Results: Exact concordance between BAL and brushing results was obtained in 443/508 (87,2%) satisfactory specimens. In 443 cases lung cancer was diagnosed by BAL cytology (329 men, 114 women; mean age 67,8 years). Lung tumors were separated into squamous cell carcinoma, adenocarcinoma, large cell carcinoma, small cell carcinomas, undifferentiated carcinoma. BAL specimens showed non-specific findings in 329 cases (74,3%) cases. No significant differences occurred in the number of brushings taken or in the bronchoscopic presentation of these cases. Except in one case (0,2%) of a false positive cytological result, malignancy was confirmed by repeated radiography and computed tomography. In 478 cases lung cancer was diagnosed by brushing alone (346 men, 132 women; mean age 64,30 years). Non-specific cytological disorders were found in 288 cases (60,3%). Examinations had to be repeated in 46 of the 528 patients either to confirm the initial results or to resolve apparent discrepancies between results and clinical data. Conclusions: Examination of bronchoalveolar lavages complements bronchial brushing cytopatholgy in both diagnosing and typing lung tumors and could be performed more systematically in patients undergoing fibreoptic bronchoscopy.

Keywords:  BAL, bronchial brushing, cytology, lung tumor