Reevaluating Utility of Bronchial Wash and Bronchioalveolar Lavage (BAL) at the Time of Transbronchial (Wang) Aspiration and Endobronchial Brushing Cytology.
Nathaniel T Sherwood, Shweta Patel. Allegheny General Hospital, Pittsburgh, PA
Background: Endobronchial cytology via transbronchial (Wang) fine needle aspiration and bronchial brushing are indispensable tools in the workup of patients with suspected pulmonary or thoracic disease. These procedures are well tolerated, cost effective, and less invasive than open surgical biopsies. The aim of this study was to evaluate the utility and diagnostic yield of bronchial brushing, transbronchial fine needle aspiration, endobronchial biopsy, bronchoalveolar lavage (BAL), and bronchial washing cytology in patients with suspected pulmonary or thoracic disease.
Design: In this study, we retrospectively evaluated cytology and surgical pathology reports from 168 total patients. These patients must have undergone bronchial brushing or endobronchial fine needle aspiration cytology. A total of 611 procedures were reviewed. These included the aforementioned as well as pleural fluid cytology, and cytology or tissue biopsy of other sites. The results were tabulated as positive for malignancy, positive for granulomatous inflammation, or negative. Diagnoses of “atypical” or “suspicious” were counted as negative.
Results: Of the 168 patients, a positive diagnosis was established in 118 with an endobronchial procedure. Of these, 12 were diagnosed with granulomatous disease, and 104 were diagnosed with malignancy. The yields were as follows: fine needle aspiration 75/214 (35.0%), bronchial brush 37/96 (38.5%), endobronchial tissue biopsy 33/95 (34.7%), bronchial wash 13/131 (9.9%), and BAL 2/44 (4.5%). Only 1 bronchial wash was positive in exclusivity, with a concomitant brushing of “suspicious”. Zero BALs were positive in exclusivity. 26 patients required either tissue (18) or cytology (9) from an open thoracotomy (9) or another site for diagnosis. 24 patients had only negative findings and required no further workup.
Conclusions: Endobronchial fine needle aspiration and bronchial brushing cytology are invaluable diagnostic modalities in patients with suspected pulmonary or thoracic disease. Of the 168 patients in this study, 144 (85.7%) required no further workup and only 9 (5.3%) required an open biopsy. Bronchioalveolar lavage and bronchial washing proved to be of limited utility. At the time of bronchoscopy, additional material in the form of aspirations, brushings, or biopsies are of the highest yield. The cytopathologist can best serve the patient and conserve medical resources by discouraging BALs and washings in this setting.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 73, Tuesday Morning