Diagnostic Efficacy of Bronchoalveolar Lavage in a Rural Industrial Hospital in Madhya Pradesh, India

Abstract

BACKGROUND The incidence of lung carcinomas is on rise and it is the second most common cause of death due to carcinomas in the West. Due to rise in air pollutants other lung diseases are also on rise. The use of cytological methods in the diagnosis of pathological lesions of respiratory tract has been generally acclaimed as one of its most successful application. Flexible fibre optic bronchoscope revolutionised respiratory cytology because techniques like broncho alveolar lavage, brush cytology, bronchial biopsy, and fine needle aspiration cytology (FNAC) have become easier and more acceptable, shifting the emphasis from advanced inoperable malignancy to use of cytology as first line diagnostic and management tool. Broncho alveolar lavage (BAL) which was originally developed as a therapeutic tool for pulmonary alveolar proteinosis, cystic fibrosis and intractable asthma also has gained acceptance and steady popularity as a tool for diagnosis of lung pathology. We wanted to analyse BAL examined in the Department of Pathology, Nehru Shatabdi Chikitsalaya (NSC), NCL and establish its utility as a diagnostic tool in our setup and reduce referral to higher centres. METHODS 36 BAL samples were examined from August 2006 to December 2007. Bronchoscopy was performed by ENT specialists among all patients who were not relieved by the medical treatment and their X-ray lung showed some findings, as an outdoor procedure. Patients were asked to come in an empty stomach, and X-ray chest was done before bronchoscopy. All bronchoscopies were performed under local anaesthesia (LA) except for a 2 yrs. old child. BAL fluid was subjected to cytological studies and Ziehl-Neelsen staining wherever required. RESULTS Out of 36 cases, nonspecific inflammation was seen in 13 cases, tuberculosis in 8 cases, where in three samples of sputum were negative for acid-fast bacillus (AFB) and BAL showed bacteria in many fields. Two cases were found to have aspergillosis, to rule out contamination, serum antibodies against aspergillosis were estimated which was very high ruling out contamination. Out of 8 cases of malignancy one was metastasis from mature teratoma testis. Two cases of adenocarcinoma (both females) and two cases of squamous cell carcinoma were found, in one case of adenocarcinoma and two cases of squamous cell carcinoma (SCC), BAL was found negative. No history was available regarding tobacco smoking in females with adenocarcinoma. CONCLUSIONS Study of BAL obtained by simple non-invasive technique has improved the diagnostic accuracy of lung diseases. Carcinomas can be diagnosed at an early operable stage. The combination of BAL with brush cytology increases the accuracy. To conclude, in all bronchoscopic examination BAL should be performed and should be subjected to microscopic examination irrespective of the age of patient. KEY WORDS Fiberoptic Bronchoscope, Lung, BAL, Tuberculosis, Adenocarcinoma Lung, SCC Lung