Bronchoalveolar lavage in the diagnosis of peripheral primary and secondary malignant lung tumors

The success rate of cytological examination of the bronchoalveolar lavage fluid (BALF) in patients with primary or metastatic lung tumors varies considerably according to different authors. In a prospective study, we have tried to establish the sensitivity of BAL in comparison with both transbronchial lung biopsy (TBB) and brushing. BAL was performed in 61 patients with lung malignancies and in 56 patients with nonmalignant lung disease: 39 patients had primary lung cancer, 22 had metastatic spread into the lungs. First the part of the lung involved was washed out with 100 ml physiological saline solution during bronchoscopy. Following BAL, 5 TBB and brushing were performed. The smears were stained by the May-Grünwald-Giemsa method. Malignant cells were found in BALF from 17 patients, in TBB specimens from 43 and in brushing smears from 26. TBB was significantly the most successful method applied. Malignant cells were never found in BALF only, nor were they ever found in patients with non-malignant lung disease. The sensitivity of the three methods was equal for primary as compared to metastatic tumors and for interstitial infiltrates as compared to coin lesions. Malignant cells were most frequently found in centrifuged specimens. BAL may be used in suspected malignant interstitial or rounded pulmonary infiltrates when it cannot be reached by forceps or brush, or when TBB and brushing are contra-indicated.