Bronchoscopy with bronchoalveolar lavage(BAL) is a recognized diagnostic tool in investigating pulmonary neoplasia, but its efficacy and sufficiency as a sampling method vary greatly. We aimed to describe the performance of bronchoscopy and the factors influencing the adequacy of BAL for lung cancer.

Methods: We retrospectively reviewed the charts of 111 patients who underwent bronchoscopy with BAL for suspicious lung lesions at our center from January to June 2018. Efficacy of bronchoscopy and BAL was assessed in providing a precise diagnosis and subtyping of lung cancer. Adequacy was described based on the final diagnosis after all investigations.

Results: Mean age of patients was 70(49-90) with 59(53%) males. Mean size of lesion was 31mm, and 75(67.7%) had a high Malignancy Risk Score (Mayo Clinic Model). In addition to BAL, bronchial/transbronchial biopsies were performed in 62(55.9%). Additional invasive sampling procedures were done in 81(73%), and a final diagnosis of lung cancer was made in 72(64.8%). Bronchoscopy provided a diagnosis in 58(52.3%), with a higher yield for abnormal endoscopic appearance(p<0.001), central tumor(p=0.006) and lesion>3cm(p=0.037). BAL showed suspicious/neoplastic cells in 20(18%) and was concordant with the definitive diagnosis in 34(30.6%). BAL identified small cell lung carcinoma(SCLC) in 3 cases, but further testing was needed in 11. Lymphangitis, higher T(TNM staging) and central lesion predicted better accuracy and efficacy, while bronchus sign and metastatic disease only influenced diagnostic yield.

Conclusion: Despite the low diagnostic yield of BAL for lung cancer at our center, bronchoscopy remains valuable in cases of lymphangitis, metastatic disease and SCLC.