Diagnostic Value of Bronchoalveolar Lavage for Diagnosis of Suspected Peripheral Lung Cancer

The usefulness of liquid-based cytology of bronchoalveolar lavage fluid combined with bronchial brush specimens in lung cancer diagnosis

Objective

To explore the diagnostic value of liquid-based cytology (LBC) of bronchoalveolar lavage fluid (BALF) combined with bronchial brushing (BB).

Methods

One hundred patients with pulmonary masses or nodules found by chest computed tomography (CT) or X-ray before bronchoscopy or other diagnostic biopsy examinations were selected consecutively for this retrospective study. BALF and BB were performed for all patients. After conventional smear via BB, we mixed the BALF and BB samples in a prepared thin-layer bottle.

Results

The sensitivity of LBC of BALF combined with BB was noticeably higher than that of BB alone in the total sample group (65.15% vs. 32.84%, respectively). Similarly, in both the bronchoscopically visible group and invisible group, a higher sensitivity for LBC of BALF with BB vs BB alone (68.89% vs. 39.13%, respectively; 57.14% vs. 19.05%, respectively) was observed. Additionally, the negative predictive value of LBC of BALF with BB was higher than that with BB alone (58.56% vs. 42.31%; 61.29% vs. 44.73%; 53.47% vs. 37.83%; total sample vs visible vs invisible groups, respectively).

Conclusion

Regardless of whether lesions or nodules are bronchoscopically visible or invisible, LBC of BALF combined with BB may increase the diagnostic value over BB alone in lung cancer diagnosis.

Application of Non-Blood-Derived Fluid Biopsy in Monitoring Minimal Residual Diseases of Lung Cancer

Lung cancer is one of the most fatal malignant tumors in the world. Overcoming this disease is difficult due to its late diagnosis and relapse after treatment. Minimal residual disease (MRD) is described as the presence of free circulating tumor cells or other tumor cell derivatives in the biological fluid of patients without any clinical symptoms of cancer and negative imaging examination after the treatment of primary tumors. It has been widely discussed in the medical community as a bridge to solid tumor recurrence. Radiology, serology (carcinoembryonic antigen), and other clinical diagnosis and treatment methods widely used to monitor the progression of disease recurrence have obvious time-limited and -specific defects. Furthermore, as most samples of traditional liquid biopsies come from patients’ blood (including plasma and serum), the low concentration of tumor markers in blood samples limits the ability of these liquid biopsies in the early detection of cancer recurrence. The use of non-blood-derived fluid biopsy in monitoring the status of MRD and further improving the postoperative individualized treatment of patients with lung cancer is gradually ushering in the dawn of hope. This paper reviews the progress of several non-blood-derived fluid samples (urine, saliva, sputum, and pleural effusion) in detecting MRD in lung cancer as well as selecting the accurate treatment for it.

Cell-free DNA from bronchoalveolar lavage fluid (BALF): a new liquid biopsy medium for identifying lung cancer

Background

Differentiating malignant lung tumors from benign pulmonary nodules is a great challenge. While the analysis of bronchoalveolar lavage fluid (BALF) is used for diagnosing infections and interstitial lung diseases, there is limited evidence to support its use for lung cancer diagnosis. This study aimed to interrogate the potential of using BALF cell-free DNA (cfDNA) to discriminate malignant lesions from benign nodules.

Methods

Fifty-three patients with solid pulmonary nodules (≤2 cm) were prospectively enrolled, including 21 confirmed with benign disease and 32 with malignant tumors. Mutations were profiled for 30 tumor tissues and 40 BALFs. Paired BALFs and plasma from 48 patients underwent DNA methylation profiling. A methylome-based classification model was developed for BALF and plasma separately.

Results

Among the 30 patients with paired tissues and BALFs, 96.7% and 70% had alterations detected from their tissues (79 alterations) and BALFs (53 alterations), respectively. Using tissues as references, BALFs revealed 14 new alterations and missed 41. BALF mutation displayed a sensitivity of 71%, specificity of 77.8%, and accuracy of 72.5% in detecting lung cancer. BALF methylation achieved an accuracy of 81.3%, with both sensitivity and specificity being 81%. Plasma methylation showed a 66.7% sensitivity, 71.4% specificity, and 68.8% accuracy. BALF methylation also demonstrated 82.4% sensitivity in stage I patients. Parallel bronchoscopy, lavage cytology, and bronchial brushing demonstrated an inferior sensitivity of 23%, 3.1%, and 9.7%, respectively, compared with BALF methylation and mutation (P<0.0001).

Conclusions

BALF cfDNA can serve as a liquid biopsy media for both mutation and methylation profiling, demonstrating better sensitivities in distinguishing small malignant tumors from benign nodules than conventional methods.

Keywords

Lung cancer diagnosis; pulmonary nodule; bronchoalveolar lavage fluid (BALF); methylation; genomic mutation

Evaluation of cytokines in the tumor microenvironment of lung cancer using bronchoalveolar lavage fluid analysis

INTRODUCTION

Lung cancer is the leading cause of death by cancer. In recent years, immunotherapy with checkpoint inhibitors (ICI) emerged as a promising new therapeutic approach. However, a deeper understanding of the immunologic responses adjacent to the tumor known as tumor microenvironment (TME) is needed. Our study investigated TME of lung cancer by analyzing cytokines in bronchoalveolar lavage fluid (BALF).

MATERIALS AND METHODS

Between January 2018 and June 2019, 119 patients were prospectively enrolled in this study. For each cancer patient, levels of 16 cytokines (fractalkine, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), and interleukins (IL): IL-1b, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p70, IL-13, IL-17A, and IL-23) were measured in BALF and serum and compared to healthy individuals and patients with other lung diseases.

RESULTS

There were several significant differences of cytokine levels of patients with lung cancer compared to healthy individuals. However, none of them remained in the multivariate analysis compared to other lung diseases in either BALF or serum. Furthermore, there were no significant differences between the groups in cell differentiation of either BALF or serum. Cytokine levels in BALF were generally near the lower detection limit and showed almost no correlation with their respective levels measured in serum of the same individual.

CONCLUSIONS

Cytokines in BALF and serum of lung cancer patients may indicate unspecific inflammation. BAL is not recommendable as a tool to investigate TME of lung cancer. Therefore, cytokines measured in BALF are probably not appropriate as predictors in patients treated with ICIs.

Bronchoalveolar lavage: role in the evaluation of pulmonary interstitial disease

INTRODUCTION

Bronchoalveolar lavage (BAL), a noninvasive, well-tolerated procedure is an important diagnostic tool that can facilitate the diagnosis of various lung diseases. This procedure allows the assessment of large alveolar compartments, by providing cells as well as non-cellular constituents from the lower respiratory tract. Alterations in BAL fluid and cells ratio reflects pathological changes in the lung parenchyma. In some cases, clinicians use BAL as a differential diagnosis guide for interstitial lung disease.

AREAS COVERED

In this review, we summarized the diagnostic criteria for BAL in interstitial lung diseases, pulmonary infections, lung cancer and other pathologies such as fat embolism, gastroesophageal reflux and collagen vascular disease. For this review, we have selected scientific papers published in the PubMed database in our area of interest. We aimed to highlight the usefulness of BAL in respiratory pathology.

EXPERT OPINION

Although BAL fluid analyzes has an essential role in the diagnostic work-up of many lung pathologies, it should be performed in selected patients. For accurate results, the BAL technique is very important to be standardized.

The Utility of Intraoperative Microbiological, Cytological, and Histopathological Sampling in the Setting of an Empyema Necessitating Lung Decortication Surgery

INTRODUCTION AND AIMS

 Empyema thoracis is a pleural space pathology that indicates accumulation of purulent material in the pleural space. It is often associated with an underlying infectious process, such as pneumonia, but can also be a ramification of a more sinister etiology, such as lung carcinoma, often warranting lung decortication surgery for prompt resolution. Although radiological imaging is used to form a preliminary diagnosis, its true predictive value remains questionable, and intraoperative microbiological, cytological, and histopathological samples are thus instrumental in yielding helpful diagnostic information. This study aims to gauge whether intraoperative microbiological, cytological, and histopathological analyses yield any additional diagnostic information in establishing the etiology underlying empyema, necessitating decortication surgery.  Methods: Microbiological, cytological, and histopathological records of 43 patients undergoing decortication surgery were included in this study. Only patients who were diagnosed with late stages of empyema and subsequently underwent decortication surgery were included in this study.  Results: The sample consisted of 43 patients, including 23 males and 20 females. For microbiology, 4.88% of the bronchoalveolar lavage (BAL) samples, 7.69% of tissue fluid samples, and 7.32% of pleural fluid samples were positive for an infectious microorganism. For cytology/histopathology, 0.00% of BAL samples, 5.41% of pleural fluid samples, and 7.32% of tissue samples were positive for an underlying infective etiology.  Conclusion: For the study and analysis of the microbiological samples, a myriad of all three different modalities of diagnosis is essential. However, tissue sampling is the preferred modality of diagnosis for cytology/histopathology owing to its ability to detect positive cases that might otherwise evade prompt detection.

Multivariate Analysis Of The Diagnostic Yield Of Conventional Bronchoscopy In Peripheral Lung Adenocarcinoma

Background

The new subtypes of lung adenocarcinoma reflect local invasive growth, pulmonary alveoli, and intraluminal spreading, while the effective improvement of the diagnostic yield of bronchoscopy still remains unclear. This study aims to explore whether the subtypes of lung adenocarcinoma and other factors affect the diagnostic yield of bronchoscopy.

Methods

All patients were performed 64-row CT examination and bronchoscopy.

Results

The bronchus cutoff sign in 48 cases and the endoscopic diagnostic yield was 60.4%. The lumen of the lobes and segments was invaded in 59 cases, and the endoscopic diagnostic yield was 54.2%.The lymph node metastasis was detected in 46 cases, and the endoscopic diagnostic yield was 60.9%. In addition, 42 cases showed acinar type-predominant, and the endoscopic diagnostic yield was 28.6%. Eighteen cases showed solid type-predominant, and the endoscopic diagnostic yield was 33.3%. The micropapillary type-predominant was noted in 17 cases, with the endoscopic diagnostic yield as 94.1%. The papillary type-predominant was in 14 cases, and the endoscopic diagnostic yield was 42.9%. The lepidic type-predominant was seen in 13 cases, and the endoscopic diagnostic yield was 7.7%. The mean diameter of tumors with a positive endoscopic diagnostic yield was 4.34±2.65cm, and the mean diameter of tumors with a negative diagnostic yield was 2.83±1.47cm. Multivariate analysis showed that micropapillary lung adenocarcinoma affected the endoscopic diagnostic yield (OR=37.594, 95% CI: 4.074-346.94) .Tumor diameter affects endoscopic diagnostic yield (OR=1.39, 95% CI: 1.073-1.802), bronchus cutoff sign is easy to obtain endoscopic diagnostic yield (OR=4.86, 95% CI: 1.606-14.704), and lymph node metastasis affects the endoscopic diagnostic yield (OR=3.696, 95% CI: 1.255-10.883).

Conclusion

The micropapillary subtype lung adenocarcinoma has a certain influence on the diagnostic yield of bronchoscopy. When the lung adenocarcinoma has a large tumor diameter, bronchus cutoff sign and lymph node metastasis, it is easy to obtain a diagnostic yield of bronchoscopy.

Effectiveness of Bronchofiberoscopy in Diagnosis of Lung Lesions

Lung cancer is the most common cause of cancer-related deaths. A short survival rate often results from belated diagnosis made in advanced stages. Therapy individualization requires the collection of a viable material for histopathological examination, which often brings difficulties. This study was performed in a group of 110 patients suspected of malignancy in chest computed tomography. All subjects underwent bronchofiberoscopy. Bronchoalveolar lavage (BAL) and endobronchial brushing were performed in all cases, whereas forceps tissue biopsy was taken if mucous membrane abnormalities were observed. In case of a negative result of bronchofiberoscopy invasive methods were implemented. A malignant neoplasm was diagnosed in 106 cases. Overall, cancer cells (positive result) were found in 45 patients (42.0%) subjected to bronchofiberoscopy. Cytology was positive in 38 (35.8%) and histopathological examination in 30 (28.3%) specimens. Eleven samples of BAL (10.3%) were positive. Endobronchial brushing was more effective, with 27 positive samples (25.5%). Forceps tissue biopsy was performed in 33 cases with 90% sensitivity. The most frequent cancer subtype found was squamous cell carcinoma. No severe complications of bronchofiberoscopy were observed. We conclude that bronchofiberosocpy is a safe diagnostic procedure for lung lesions, but its sensitivity and specificity are low. Only when there are mucous macroscopic changes observed, a precise diagnosis is possible.