Pulmonary Procedures |

The Diagnostic Yield of Bronchoalveolar Lavage and Transbronchial Lung Biopsy in Pulmonary Lymphangitic Carcinomatosis FREE TO VIEW

Amera Rahmatullah, MBBS; Kamran Mahmood, MD
Author and Funding Information

Duke University Hospital, Riyadh, NC

Chest. 2015;148(4_MeetingAbstracts):786A. doi:10.1378/chest.2270027
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SESSION TITLE: Bronchoscopy Poster Discussions

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Wednesday, October 28, 2015 at 11:00 AM - 12:15 PM

PURPOSE: To evaluate the diagnostic yield of bronchoalveolar lavage (BAL) and transbronchial biopsy (TBBx) in patients with pulmonary lymphangitic carcinomatosis.

METHODS: A retrospective study reviewing fiberptic bronchoscopic records of patients with underlying malignancy from March 2013 to April 2015 at Duke University Medical Center, Durham, NC was performed. Forty Seven patients were identified who underwent fiberoptic bronchsocpy to evaluate radiological findings suggestive of lymphangitic carcinomatosis. The following information was recorded: Demographic data, presenting symptoms, site of primary neoplasm, radiographic findings, bronchoscopic findings, BAL, TBBx histology and complications of fiberoptic bronchsocopy.

RESULTS: There were 47 patients included in this study, 27 men and 20 women with a mean age of 66.5 (SD age 11.335). The primary neoplasm was adenocarcinoma of the lung in 20 of the 47 patients (42.5%), squamous cell carcinoma of the lung in 11 patients (23.4%), poorly differentiated non small cell lung cancer (NSCLC) in 4 patients (8.5%), breast cancer in 7 patients (14.9%), colorectal cancer in 2 patients (4.2%), ovarian cancer in 1 patient (2.1%), renal cancer in 1 patient (2.1%) and pancreatic cancer in 1 patient (2.1%). The presenting symptoms were dyspnea in 27 patients (57.4%), non-productive cough in 23 of them (48.9%), and hemoptysis in 6 of them (12.8%). Nodular opacities were present on radiographic findings in 31 patients (65.9%), Interlobular septal thickening was found in 27 patients (57.4%), and groundglass opacities were found in 20 opatients (42.5%). BAL specimens were obtained from 33 patients, 13 of them had positive results (39.4%), transbronchial biopsies were obtained from 28 patients, 19 of them had positive results (67.8%) with a statistically significant difference (P <0.05). 3 patients underwent open lung biopsy with positive results in all 3 (100%). 1 patient who underwent TBBx had pneumothorax (2.1%). 14 patients were deceased (29.7%) at the time of record review.

CONCLUSIONS: In patients with underlying neoplasm and radiographic findings suggestive of lymphangitic carcinomatosis, TBBx has a higher diagnostic yield when compared to BAL.

CLINICAL IMPLICATIONS: This study suggests that TBBx is preferred to confirm the diagnosis of pulmonary lymphangitic carcinomatosis.

DISCLOSURE: The following authors have nothing to disclose: Amera Rahmatullah, Kamran Mahmood

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