Binesh Fariba, Pirdehghan Azar, Mirjalili Mohammad Reza, Samet Mohammad, Majomerd Zahra Amini, Akhavan Ali
Department of Pathology, Shahid Sadoughi University of Medical Sciences, Iran E-mail :
Asian Pac J Cancer Prev. 2015;16(1):201-4. doi: 10.7314/apjcp.2015.16.1.201.
This study was designed to determine the accuracy of bronchoalveolar lavage fluid cytology (BAL) using histopathologic examination of transbronchial biopsy specimens as the gold standard in diagnosis of lung carcinoma at our center.
A retrospective study was conducted to investigate a total of 388 patients who were suspected of having lung cancer and had undergone fiberoptic bronchoscopy in Shahid Sadoughi hospital from 2006 to 2011. Lung masses were proven to be malignant by histology.
Transbronchial lung biopsy (TBLB) identified malignancy in 183 of the 388 cases, including 48 cases (26.2%) with adenocarcinoma, 4(2.1%) with bronchioloalveolar carcinoma, 47(25.6%)with squamous cell carcinoma, 34(18.5%) with well-diffentiated neuroendocrine carcinoma, 35(19.1%) with small cell carcinoma, 14 (7.6%) with non-small cell carcinoma, and 1 (0.54%) with large cell carcinoma. A total of 205 cases were correctly classified as negative. BAL was also performed in 388 patients; 86/103 cases were consistent with the final diagnosis of lung cancer and 188/285 cases were correctly classified as negative. The sensitivity of BAL was 46.9%(CI:41.9%, 51.8%)) and its specificity was 91.6%(CI:88.8%, 94.3%). BAL had a positive predictive value (PPV) of 83.4%(CI:79.7%, 87.1%) and a negative predictive value (NPV) of 65.8%(CI:61%, 70.5%). The overall accuracy of BAL was 70.5% and the exact concordance was 39%.
Our findings suggest that BAL cytology is not sensitive but is a specific test for diagnosis of lung carcinoma. If transbronchial lung biopsy is combined with bronchoalveolar lavage, the positive diagnostic rate will be further elevated.
本研究旨在以经支气管活检标本的组织病理学检查作为金标准，确定支气管肺泡灌洗术（BAL）在本中心诊断肺癌中的准确性。
进行一项回顾性研究，调查2006年至2011年期间在沙希德·萨杜基医院接受纤维支气管镜检查且疑似患有肺癌的388例患者。经组织学证实肺部肿块为恶性。
经支气管肺活检（TBLB）在388例病例中确诊183例为恶性，其中腺癌48例（26.2%），细支气管肺泡癌4例（2.1%），鳞状细胞癌47例（25.6%），高分化神经内分泌癌34例（18.5%），小细胞癌35例（19.1%），非小细胞癌14例（7.6%），大细胞癌1例（0.54%）。共有205例被正确分类为阴性。对388例患者也进行了BAL；103例中的86例与肺癌最终诊断一致，285例中的188例被正确分类为阴性。BAL的敏感性为46.9%（CI：41.9%，51.8%），特异性为91.6%（CI：88.8%，94.3%）。BAL的阳性预测值（PPV）为83.4%（CI：79.7%，87.1%），阴性预测值（NPV）为65.8%（CI：61%，70.5%）。BAL的总体准确性为70.5%，确切一致性为39%。
我们的研究结果表明，BAL细胞学检查对肺癌诊断不敏感，但具有特异性。如果将经支气管肺活检与支气管肺泡灌洗相结合，阳性诊断率将进一步提高。
