Published: 2018-08-25

Diagnostic efficacy of bronchoalveolar lavage (BAL) in lung malignancies

Shubhra Tayal, Chandrashekhar P. Bhale


Background: Lung malignancies are the leading cause of cancer related deaths in men and in women it has surpassed even breast cancer. With the development of flexible fiber-optic bronchoscope, respiratory cytology has newer approach as samples like bronchial washings, bronchial brushings, bronchoalveolar lavage and trans-bronchial needle aspirations could be collected from the respiratory tract, yielding significant amount of cytological material.

Methods: A prospective study conducted in department of pathology in MGM Medical College and Hospital, Aurangabad during a period from November 2015 to October 2017. 48samples of bronchoalveolar lavage received and patient data collected.

Results: About 48 cases included in the study comprised of 23 (47.92%) malignancies, 16 (33.34%) DLDs and 9 (18%) cases of tuberculosis. In our study, 23 cases of malignancy included 15 male and 8 female patients (male:female ratio= 1.87). Mean age for malignancy was 57.57 years with median age of 60 years. Among 23 cases of malignancies 11 were given as positive/suspicious/atypical cells on BAL, whereas 10 out of 11 bronchial brushing were given as positive/suspicious or suggestive of malignancy.

Conclusions: Bronchoalveolar lavage is useful procedure. Efficacy of BAL is increased when used in combination with bronchial brushing.


Bronchoalveolar lavage, Bronchial brushing, Malignancies, Lung

Full Text:



Drent M. Interpretation of bronchoalveolar lavage fluid cytology. 2001:1-6.

Meyer KC, Raghu G, Baughman RP, Brown KK, Costabel U, Du Bois RM, et al. An official American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease. Am J Res Crit Care Med. 2012 May 1;185(9):1004-14.

Kylstra JA, Rausch DC, Hall KD, Spock A. Volume-controlled lung lavage in the treatment of asthma, bronchiectasis, and mucoviscidosis. Am Rev Respir Dis. 1971;103:651-955.

Hyaret R. Pulmonary host defences. I. Analysis of protein and lipids in bronchial secretions and antibody responses after vaccination with pseudomonas aeruginosa. J Immunol. 1973;831:358-68.

Bhat N, Nazeir MJ, Bashir H, Bashir N, Farooq S, Fatima K, et al. Correlation of bronchial biopsy with bronchoalveolar lavage in lung malignancies. Inter J Res Med Sci. 2016;4(2):428-35.

Radha S, Afroz T, Prasad S, Ravindra N. Diagnostic utility of bronchoalveolar lavage. J Cytology/Indian Academy Cytologists. 2014 Jul;31(3):136.

Reddy A, Vivekanand N, Durga K. Efficacy of bronchial wash and brush cytology in the diagnosis of lung cancers. Sch J App Med Sci. 2014;2:816-20.

Sareen R, Pandey CL. Lung malignancy: Diagnostic accuracies of bronchoalveolar lavage, bronchial brushing, and fine needle aspiration cytology. Lung India. 2016;33:635-41.

Kotadia TP, Jasani JH, Vekaria PN. Comparison of bronchial biopsy, bronchoalveolar lavage (BAL), brush cytology and imprintcytology in suspected cases of lung cancer. IJBAR. 2013;04(09).

Gaur DS, Thapliyal NC, Kishore VS, Pathak VP. Efficacy of bronchoalveolar lavage and bronchial brush cytology in diagnosing lung cancers. J cytology. 2007;24(2):73-77.

Radke JR, Conway WA, Eyler WR, Kvale PA. Diagnostic accuracy in peripheral lung lesions: factors predicting success with flexible fiberoptic bronchoscopy. Chest. 1979;76:176-79.

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.

Johnston WW, Elson CE. Respiratory tract. In: Bibbo M, editor. Comprehensive cytopathology. 2nd ed. Philadelphia: W.B. Saunders Company;1997:325-401.

Truong LD, Underwood RD, Greenberg SD, McLarty JW. Diagnosis and typing of lung carcinomas by cytopathologic methods. A review of 108 cases. Acta Cytol. 1985;29:379-84.

Govert JA, Kopita JM, Matchar D, Kussin PS, Samuelson WM. Cost effectiveness of collecting routine cytologic specimens during fiberoptic bronchoscopic for endoscopically visible lung tumours. Pol Arch Med Wewn. 2002;108:1193-7.

Bedrossian CWM, Rybka DL. Bronchial brushing during fiberoptic bronchoscopy for the cytodiagnosis of lung cancer: comparison with sputum and bronchial washings. Acta Cytol. 1976;20:446-53.