Category: Carcinomatosis

The Value of Bronchial Washings and Bronchoalveolar Lavage in the Diagnosis of Lymphangitic Carcinomatosis: DiscussionDiffuse interstitial pulmonary infiltrates in patients with underlying malignant disease has a wide differential diagnosis. Transbronchial lung biopsy has been advocated as being the procedure of choice for establishing the diagnosis. Ventilation-perfusion lung scan demonstrating an irregular peripheral perfusion defect has been suggested to be helpful in raising the suspicion of lymphangitic carcinomatosis but has poor specificity and undocumented sensitivity. Bron-choalveolar lavage is a safe, commonly used procedure which has been referred to as a “liquid biopsy of the lung.” A wide variety of inflammatory and infectious diseases have been documented by BAL, but its use in diagnosing neoplastic disease has been limited. …Read the rest of this article

The Value of Bronchial Washings and Bronchoalveolar Lavage in the Diagnosis of Lymphangitic CarcinomatosisIn patients with underlying neoplastic disease, the presumptive diagnosis of lymphangitic carcinomatosis is usually based on a characteristic but not pathognomonic radiographic pattern of progressive diffuse reticular interstitial pulmonary infiltration with or without hilar enlargement. Invasive diagnostic procedures that are used to confirm the diagnosis include open lung biopsy, percutaneous aspiration needle biopsy, and transbronchial lung biopsy;2 however, these procedures pose significant risks and may be deemed unacceptable in patients with underlying advanced malignant neoplasms. Less invasive methods of confirming the diagnosis would clearly be desirable. Bronchoalveolar lavage (BAL) is a generally safe and well-tolerated procedure. The purpose of this study is to assess the sensitivity of bronchial washings and BAL in confirming lymphangitic spread of cancer. …Read the rest of this article

Twelve patients with lymphangitic carcinomatosis who satisfied the criteria for inclusion and exclusion in this study were identified. There were ten women and two men whose ages ranged from 37 to 74 years, with a mean of 58 years (Table 1). The primary lesion was adenocarcinoma of the breast in eight (67 percent) of the 12 patients, adenocarcinoma of the prostate in one, adenocarcinoma of the colon in one, transitional cell carcinoma of the bladder in one, and squamous cell carcinoma of the lung in one patient. The tumor was classified as an adenocarcinoma in a total of ten (83 percent) of the 12 patients. One patient had prolongation of the prothrombin time, and another had thrombocytopenia precluding transbronchial lung biopsy. Severe agitation and uncontrolled cough precluded brushings and transbronchial lung biopsy in an additional patient. add comment …Read the rest of this article