The Value of Bronchial Washings and Bronchoalveolar Lavage in the Diagnosis of Lymphangitic Carcinomatosis
In 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.
Materials and Methods
A six-year (1981 to 1987) review of the fiberoptic bronchoscopic records of patients with underlying malignant disease at the City of Hope National Medical Center, Duarte, was performed. Twelve patients were identified who underwent fiberoptic bronchoscopy to evaluate radiographic findings suggestive of lymphangitic carcinomatosis. Patients were excluded if discrete pulmonary nodules suggestive of hematogenous metastasis were present on the chest x-ray film or if an endobronchial lesion was visualized at bronchoscopy. The following information was recorded: demographic data; hematologic and coagulation parameters; radiographic findings; histology and site of the primary neoplasm; bronchoscopic findings; cytologic results of sputum, bronchial washings, BAL, and birushings; and histology of transbronchial biopsy specimens. It was noted whether any complications of fiberoptic bronchoscopy had occurred. Bronchoalveolar lavage of the right middle lobe or lingula was performed using 20 ml aliquots of physiologic saline solution to a total volume of 200 ml, according to published methods.