Wannasai Komson, Kongkarnka Sarawut, Lertprasertsuke Nirush, Phinyo Phichayut, Namwong Chindanai, Yaowarat Tanapol, Suwatwiriyapong Phurinut, Vacharothone Pongsapat, Chankasemporn Sansern, Dankai Wiyada, Chowsilpa Sayanan
Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Center of Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Cytojournal. 2025 Apr 9;22:43. doi: 10.25259/Cytojournal_205_2024. eCollection 2025.
This study investigates the diagnostic concordance between bronchoalveolar lavage (BAL) cytology and the histologic analysis of transbronchial lung biopsy (TBLB) specimens in patients with suspected pulmonary diseases to highlight the strengths and limitations of these complementary diagnostic tools.
We conducted a comprehensive retrospective cross-sectional analysis on patients suspected of pulmonary diseases who underwent both BAL and TBLB from 2018 to 2022. We assessed diagnostic agreement using kappa statistics and calculated the overall concordance rates. The analysis was stratified based on malignant versus infectious etiologies to elucidate performance differences between the two methods.
Our study included a cohort of 189 patients, comprising 104 individuals with suspected malignancy and 85 with suspected infections. Among the malignancy group, BAL yielded positive results for cancer in 49 patients, whereas TBLB confirmed malignancy in 64 patients, demonstrating an overall agreement of 70.19% (kappa = 0.52, 95% confidence interval [CI]: 0.38-0.66). Conversely, within the infectious cohort, BAL identified micro-organisms in only five patients, while TBLB diagnosed infection in 22 patients, achieving an overall agreement of 77.65% (kappa = 0.29, 95% CI: 0.17-0.41).
Our findings underscore the critical role of BAL cytology in the diagnosis of pulmonary carcinoma and infectious processes while also revealing its limitations in detecting interstitial lung diseases. The TBLB procedure emerges as an indispensable technique for accurate histopathological evaluation in lung cancer diagnostics. The integration of BAL and TBLB not only enhances diagnostic yield but also provides a more comprehensive understanding of pulmonary pathologies. Notably, we found moderate agreement between BAL and TBLB in neoplastic cases and fair agreement in non-neoplastic conditions, suggesting a nuanced interplay between these methodologies that could inform clinical practice and improve patient outcomes. This study advocates a combined approach in diagnostic frameworks to optimize the management of patients with suspected pulmonary diseases, paving the way for more precise and effective diagnoses in the field of cytology.
本研究调查疑似肺部疾病患者的支气管肺泡灌洗（BAL）细胞学检查与经支气管肺活检（TBLB）标本组织学分析之间的诊断一致性，以突出这些互补诊断工具的优势和局限性。
我们对2018年至2022年期间接受BAL和TBLB检查的疑似肺部疾病患者进行了全面的回顾性横断面分析。我们使用kappa统计量评估诊断一致性，并计算总体一致率。分析根据恶性与感染性病因进行分层，以阐明两种方法之间的性能差异。
我们的研究纳入了189例患者，其中104例疑似恶性肿瘤，85例疑似感染。在恶性肿瘤组中，BAL检查有49例患者癌症呈阳性结果，而TBLB确诊恶性肿瘤的有64例患者，总体一致性为70.19%（kappa = 0.52，95%置信区间[CI]：0.38 - 0.66）。相反，在感染组中，BAL仅在5例患者中发现微生物，而TBLB诊断出22例感染患者，总体一致性为77.65%（kappa = 0.29，95% CI：0.17 - 0.41）。
我们的研究结果强调了BAL细胞学检查在肺癌诊断和感染过程中的关键作用，同时也揭示了其在检测间质性肺病方面的局限性。TBLB程序是肺癌诊断中准确组织病理学评估不可或缺的技术。BAL和TBLB的结合不仅提高了诊断率，还能更全面地了解肺部病变。值得注意的是，我们发现BAL和TBLB在肿瘤病例中有中度一致性，在非肿瘤情况下有一般一致性，这表明这些方法之间存在细微的相互作用，可为临床实践提供参考并改善患者预后。本研究提倡在诊断框架中采用联合方法，以优化疑似肺部疾病患者的管理，为细胞学领域更精确有效的诊断铺平道路。
