Published: 2022-06-28

Role of bronchoalveolar lavage in the diagnosis of lung cancer

Shish Mohammad Sarkar, Julekha Khatun, A. K. M. Mosharraf Hossain, Mohammad Atiqur Rahman, Shamim Ahmed, Rajashish Chakrabortty


Background: Early diagnosis of lung cancer plays a vital role in reducing the lung cancer death rate. Different modalities can be applied e.g. radiology, bronchoscopy, bronchoalveolar lavage (BAL), and fine needle aspiration cytology. Cytological diagnostic techniques are safer, economical, and provide quick results. The aim of the study was to find out diagnostic yields of bronchoalveolar lavage in diagnosing lung cancer, and to determine the sensitivity, and specificity of BAL fluid cytology considering the bronchial biopsy as the gold standard.

Methods: This cross-sectional study was carried out in the Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period from November 2018 to March 2020 with a total of 38 participants.

Results: 33 (86.84%) patients were male, and 5 (13.16%) were female; the mean age was 58.29±13.11 years. In clinical presentations, cough was present in all 100% of the patients, and some more frequent presentations were shortness of breath in 26 (68.4%), hemoptysis in 24 (63.15%), and chest pain in 21 (55.26%). Majority of the patients (78.95%) were smokers. Considering histopathological findings, maximum patients had squamous cell carcinoma 13 (38.23%), then adenocarcinoma 11 (32.35%), small cell carcinoma 5 (14.70%), large cell carcinoma 3 (8.82%), and poorly differentiated non-small cell carcinoma 2 (5.88%). The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of BAL were 70.59%, 100%, 100%, 28.57%, and 73.68% respectively.

Conclusions: BAL fluid cytology is a useful tool for the diagnosis of lung cancer. It has good sensitivity, and specificity, and shows nearly identical information as biopsy.


Bronchoalveolar, Cancer, Lesion, Lavage, BAL

Full Text:



Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. Cancer J Clin. 2005;55(2):74-108.

Ferlay J. GLOBOCAN 2008 v1. 2, Cancer incidence and mortality world-wide: IARC Cancer Base No. 10. Available at: http://globocan.iarc.2010. Accessed on 10 March 2022.

Prabhakar B, Shende P, Augustine S. Current trends and emerging diagnostic techniques for lung cancer. Biomed Pharmacotherap. 2018;106:1586-99.

Luqman M, Javed MM, Daud S, Raheem N, Ahmad J, Khan AU. Risk factors for lung cancer in the Pakistani population. Asian Pac J Cancer Prev. 2014;15(7):3035-9.

Akhtar PS, Masud ZM, Alam MT, Begum M. Profile of lung cancer: a one-year report. J Med. 2011;12(2):115-9.

Buccheri G, Ferrigno D. Lung cancer: clinical presentation and specialist referral time. Eur Resp J. 2004;24(6):898-904.

Ahmed K, Kawsar AA, Kawsar E, Emran AA, Jesmin T, Mukti RF, Rahman M, Ahmed F. Early detection of lung cancer risk using data mining. Asian Pac J Cancer Prev. 2013;14(1):595-8.

Raiza D, Rout S, Reddy KP, Ramalaxmi PV, Prithvi BK, Harikishan KS. Efficacy of bronchial wash and brush cytology and its correlation with biopsy in lung lesions. Int J Health Res Mod Integr Health Sci. 2014;3(21):4.

Gaur DS, Thapliyal NC, Kishore S, Pathak VP. Efficacy of broncho-alveolar lavage and bronchial brush cytology in diagnosing lung cancers. J Cytol. 2007;24(2):73.

Li J, Chen P, Li XQ, Bao QL, Dai CH, Ge LP. Elevated levels of survivin and livin mRNA in bronchial aspirates as markers to support the diagnosis of lung cancer. Int J Cancer. 2013;132(5):1098-104.

Ralston SH, Penman ID, Strachan MW, Hobson R, editors. Davidson's Principles and Practice of Medicine E-Book. Elsevier Health Sciences. 2018.

Binesh F, Pirdehghan A, Mirjalili MR, Samet M, Majomerd ZA, Akhavan A. Comparative assessment of the diagnostic value of transbronchial lung biopsy and bronchoalveolar lavage fluid cytology in lung cancer. Asian Pac J Cancer Prev. 2015;16(1):201-4.

Sharma K, Prasad SC. Efficacy of bronchoalveolar lavage in diagnosing lung malignancy. Int J Med Health Sci. 2017;6(2):119-123.

Raiza D, Rout S, Reddy KP, Ramalaxmi PV, Prithvi BK, Harikishan KS. Efficacy of bronchial wash and brush cytology and its correlation with biopsy in lung lesions. Int J Health Res Mod Integr Health Sci. 2014;3(21):4.

Sharma R, Desai H, Malukani P, Gonsai RN, Goswami HM. Comparison of bronchoalveolar lavage cytology and biopsy in lung malignancy. Int J Curr Res Rev. 2014;6(5):43.

Pradeep KL, Rudramurthy KG, Srinivasa M, Avanthi E. Comparison of effectiveness of BAL [bronchoalveolar lavage] with CT Guided FNAC in the diagnosis of lung cancer. J Evol Med Dent Sci. 2014;3(11):2752-7.

Aggarwal R, Gupta K. Yield Of Different Bronchoscopic Techniques In Diagnosis Of Lung Cancer. J Cancer Res Therap. 2017;13.

Husain AN. The lung. In: Kumar V, Abbas AK, Fausto N, editors. Robbins, and Cotran pathologic basis of disease. 7th ed. India: Saunders. 2004;711-72.

Shenoy MD, Shetty P. Diagnostic accuracy of bronchoalveolar lavage in lung lesions. Ann Pathol Lab Med. 2018;5(1):57-9.

Choudhary PK, Nepal N, Mainali N, Ghimire RH. Diagnostic role of bronchoalveolar lavage: A cytohistopathological correlation. J Pathol Nepal. 2019;9(1):1441-4.