A cytological comparison of efficacy of bronchioalveolar lavage, transbronchial needle aspiration and image guided fine needle aspiration for diagnosis of pulmonary lesions in a rural tertiary care centre

Introduction: Pulmonary lesions include a wide variety of benign and malignant conditions of lung, pleura, mediastinum and vertebrae. Lung cancer is a frequently diagnosed cancer worldwide.1 Although clinical data, location and radiological findings can narrow down the diagnostic possibilities, a cytological diagnosis is warranted before initiating the specific treatment for the malignant disease. Aims and Objectives: The present study was undertaken with the aim to compare the sensitivity and specificity of bronchioalveolar lavage (BAL), transbronchial needle aspiration cytology (TBNA) and image-guided fine needle aspiration cytology (FNAC) in the evaluation of patients with pulmonary lesions. Materials and Methods: The present study was conducted on 100 patients with pulmonary lesions coming to the department of pulmonary medicine at MMIMSR, Mullana. For diagnostic purposes various procedures like BAL, TBNA and image guided FNAC were performed. Cytological examination was carried out in the department of Pathology. Results: Among 100 cases, TBNA was done in 63 cases, BAL in 52 cases and image guided FNAC was performed in 37 cases. Using these cytological techniques, a diagnosis was obtained in 81% cases. The sensitivity and specificity of each technique was assesed. On cytological evaluation, 12% cases had a non-neoplastic diagnosis, whereas 69% cases, malignancy was diagnosed. However, in 19% cases no diagnosis was offered. The most common diagnosis amongst malignant lesions was non-small cell carcinomas. (Squamous cell carcinoma- 28%, Adenocarcinoma-23%) followed by small cell carcinoma (8%). Conclusion: Image-guided FNAC of pulmonary lesions is a simple, safe, economically viable technique with low morbidity and offers quick and early diagnosis. Our study revealed that TBNA and FNAC were comparatively better in the diagnosis when compared to BAL.