Bronchoalveolar lavage in the diagnosis of cancer

Bronchoalveolar lavage (BAL) is a widely used clinical procedure. To determine if BAL could provide useful information in the detection of cancer, 850 lavages from 421 patients having BAL for a variety of indications, 50 lavages in patients with Hodgkin's disease and 20 patients with breast cancer undergoing bone marrow transplant were reviewed. BALs were performed with 5 successive 20 cc aliquots in a wedged position. The return from the first aliquot was processed separately from the subsequent four aliquots. Diff-Quik stained cytocentrifuge preparations and Papanicolaou stained millipore filter preparations were analyzed. Thirty-five patients had biopsy-proven lung cancer. In 24 (68.6%) of these, BAL revealed cells diagnostic of malignancy. There were no false positives. Six out of 50 Hodgkin's disease patients had Reed Sternberg cells detected on BAL, and 7/20 breast cancer patients had malignant cells on BAL prior to chemotherapy. In summary, the routine performance of BAL, an easily performed and well-tolerated procedure, may prove to be useful in the routine assessment of patients for cancer.