Zhang Xin, Kuang Yukun, Zhang Yuan, He Kai, Lechtzin Noah, Zeng Mingying, Yung Rex C, Xie Canmao
Department of Respiratory Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China;; Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA;; Institute of Respiratory Diseases, Sun Yat-sen University, Guangzhou 510275, China.
Department of Respiratory Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China;; Institute of Respiratory Diseases, Sun Yat-sen University, Guangzhou 510275, China.
J Thorac Dis. 2016 Nov;8(11):3245-3254. doi: 10.21037/jtd.2016.11.06.
Bronchoscopies are extensively adopted for diagnosing and staging thoracic malignancies, but studies are missing as how to keep the process streamlined and more efficient. To evaluate current role of bronchoalveolar lavage (BAL) for cancer and possible infection diagnosis when practicing comprehensive bronchoscopy for patients suspected with thoracic malignancy, and provide foundation for possible practice modification.
We retrospectively analyzed a prospectively kept database of immunocompetent patients undergoing bronchoscopy for suspected non-hematologic malignancies. Clinical, radiographic data, bronchoscopic sampling techniques and diagnostic results were recorded. Initially undiagnostic patients were followed up for 2 years for a definitive diagnosis.
Of 224 patients included, 179 (79.9%) were confirmed with active thoracic malignancies. BAL diagnostic yield of cancer based on different radiographic characters of target lesion are as follow: isolated lymphadenopathies 0%, central lesions 45.5%, peripheral masses (diameter ≥3 cm) 21.4%, peripheral large nodules (2≤ diameter <3 cm) 15.8%, and peripheral small nodules (diameter <2 cm) 7.1%, while composite bronchoscopy achieved diagnostic yield of 93.3%, 95.5%, 91.7%, 76.9%, and 66.7% in corresponding lesion types. No cancer was diagnosed solely by BAL-cytology. Proportions of patients with positive BAL culture did not differ significantly between patients with and without pre-test suspicion for infections (P=0.199). In multivariable analysis, infections were associated with age ≥75 (OR 3.0; 95% CI: 1.29-7.06), chronic obstructive pulmonary disease (COPD) (OR 2.7; 95% CI: 1.14-6.26) and diabetes mellitus (DM) (OR 4.5; 95% CI: 1.90-10.44).
Omitting BAL cytology in settings of comprehensive bronchoscopy may not compromise cancer diagnosis. For patients primarily suspected with thoracic malignancy, performing BAL culture only based on clinical suspicion could miss important infectious etiology.
支气管镜检查被广泛用于诊断和分期胸部恶性肿瘤，但关于如何使该过程更简化、更高效的研究尚缺。为评估支气管肺泡灌洗（BAL）在疑似胸部恶性肿瘤患者进行全面支气管镜检查时对癌症及可能感染诊断的当前作用，并为可能的操作改进提供依据。
我们回顾性分析了一个前瞻性建立的数据库，该数据库包含因疑似非血液系统恶性肿瘤而接受支气管镜检查的免疫功能正常患者。记录临床、影像学数据、支气管镜采样技术及诊断结果。对最初未确诊的患者随访2年以明确诊断。
纳入的224例患者中，179例（79.9%）确诊为活动性胸部恶性肿瘤。基于靶病变不同影像学特征的BAL对癌症的诊断率如下：孤立性淋巴结病为0%，中央病变为45.5%，外周肿块（直径≥3 cm）为21.4%，外周大结节（2≤直径<3 cm）为15.8%，外周小结节（直径<2 cm）为7.1%，而综合支气管镜检查在相应病变类型中的诊断率分别为93.3%、95.5%、91.7%、76.9%和66.7%。单纯通过BAL细胞学未诊断出癌症。在预试验时怀疑有感染和无感染的患者中，BAL培养阳性患者的比例无显著差异（P = 0.199）。在多变量分析中，感染与年龄≥75岁（比值比[OR] 3.0；95%置信区间[CI]：1.29 - 7.06）、慢性阻塞性肺疾病（COPD）（OR 2.7；95% CI：1.14 - 6.26）和糖尿病（DM）（OR 4.5；95% CI：1.90 - 10.44）相关。
在综合支气管镜检查中省略BAL细胞学检查可能不会影响癌症诊断。对于主要怀疑有胸部恶性肿瘤的患者，仅基于临床怀疑进行BAL培养可能会遗漏重要的感染病因。
