The Value of Bronchial Washings and Bronchoalveolar Lavage in the Diagnosis of Lymphangitic Carcinomatosis: Results
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
Cytologic analysis of sputum showed neoplastic cells in two (50 percent) of four patients, although these results were not available prior to bronchoscopy. Bronchial washings confirmed neoplastic cells in both of these patients and in an additional two patients (total, four of seven, 57 percent). Bronchoalveolar lavage revealed malignant cells in all five patients who underwent this procedure (100 percent). Respiratory tract secretions from any source confirmed the diagnosis in nine (75 percent) of the 12 patients. Bronchial brushings were obtained in five patients and were positive in only two (40 percent) of those five, both of whom also had malignant cells in bronchial washings. Transbronchial lung biopsy under fluoroscopic guidance was performed in nine patients, and histologic documentation of lymphangitic spread was obtained in four (44 percent) of those nine. In only one patient did the transbronchial biopsy provide unique information to confirm lymphangitic carcinomatosis. One patient required open lung biopsy to prove the diagnosis after a nondiagnostic bronchoscopy, and in one patient the diagnosis was not confirmed prior to death (BAL was not done in either patient). One patient had a significant pulmonary hemorrhage following transbronchial lung biopsy, but no complications occurred that were attributable to BAL.
Table 1—Clinical and Diagnostic Details of Patients with Lymphangitic Carcinomatosis
|Patient, Sex, Age (yr)||PrimaryCancer||Sputum||BronchialWashings||BAL||BronchialBrushings||TransbronchiBiopsy|
|12,F,51||Breast||Positive||…§||. . .§|