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Bronchoalveolar Lavage (BAL) for Research; Obtaining Adequate Sample Yield
Published on: March 24, 2014
Clinical utility of bronchoalveolar lavage in pediatric cancer patients
Julie R Park1, Shana Fogarty, Thomas V Brogan
1Department of Pediatrics, Division of Pediatric Hematology/Oncology, Children's Hospital and Regional Medical Center, University of Washington Medical School, Seattle, Washington 98105, USA. ipark2@chmc.org
Insights
Bronchoalveolar lavage (BAL) aids in diagnosing lung disease in pediatric cancer patients, with both positive and negative results impacting treatment. BAL is a safe initial diagnostic test given the high mortality rate in this population.
Area of Science:
- Pediatric Oncology
- Pulmonology
- Critical Care Medicine
Background:
- Pulmonary disease presents a significant challenge in pediatric cancer patients.
- Bronchoalveolar lavage (BAL) is frequently used to diagnose lung complications in immunocompromised children.
Purpose of the Study:
- To evaluate the diagnostic and clinical utility of Bronchoalveolar lavage (BAL).
- To assess the safety and effectiveness of BAL in pediatric cancer patients with pulmonary disease.
Main Methods:
- Retrospective review of 53 BAL procedures in pediatric cancer patients with pulmonary disease (1988-1998).
- Exclusion of patients who underwent prior myeloablative therapy.
Main Results:
- BAL provided a specific diagnosis in 30% of patients (15 infections, 1 malignancy).
- Medical management was altered in 26% of patients based on negative BAL results.
- Minor complications occurred in 40% of patients; severe complications in 8%.
Conclusions:
- BAL results, both positive and negative, are valuable for managing pulmonary disease in pediatric cancer patients.
- The low complication rate and high mortality support BAL as an initial diagnostic test.
Background:
Pulmonary disease in the pediatric cancer patient continues to pose a difficult clinical dilemma. Bronchoalveolar lavage (BAL) is commonly utilized for the diagnosis of pulmonary complications in the immunocompromised child.
Procedure:
We retrospectively reviewed 53 BAL procedures performed in pediatric cancer patients with pulmonary disease between 1988 and 1998 to determine the diagnostic and clinical utility of BAL. Patients who had undergone prior myeloablative therapy were excluded from analysis.
Results:
The majority of patients (83%) had an underlying diagnosis of acute leukemia or lymphoma. BAL yielded a specific diagnosis in 16 patients (30%), including 15 infections and 1 malignant infiltration. Medical management was altered in an additional 14 patients (26%) as a consequence of a negative BAL result. Severe but transient complications associated with the BAL procedure occurred in four patients (8%). Minor complications following the BAL occurred in 21 patients (40%) and included transiently increased oxygen requirement and anesthesia-related gastrointestinal complaints. The mortality from lung disease in this patient population was 7.5%.
Conclusions:
Both positive and negative BAL results contribute to the management of pediatric cancer patients with pulmonary disease. The low incidence of significant complications associated with BAL and the high mortality rate in this patient population support the choice of BAL as an initial diagnostic test in pediatric cancer patients with pulmonary disease.
