Detection of non-haematolymphoid malignancies in bronchoalveolar lavages–A cancer centre’s 10 year experience

Introduction: Fibreoptic bronchoscopy with bronchoalveolar lavage (FOB-BAL) is often performed in immunocompromised and cancer patients to investigate possible infectious and non-infectious causes of clinical and radiological respiratory abnormalities. Knowledge of the incidence and distribution of non-haematolymphoid malignancies (NHLM) detected by FOB-BAL in this population is limited. Method: Our pathology electronic database was searched from July 1, 2008 to June 30, 2018 for BAL specimens with diagnoses of “malignant” and a review of the pathology report and electronic medical record was performed. Statistical analyses were performed to determine the incidence, distribution of NHLM, and demographics of patients in these BALs. Results: A total of 209 (1.92%) out of 11 035 BAL cases were reported in the “malignant” category. After exclusion of 22 cases with haematolymphoid malignancies, 187 cases were included in this study. The average patient age was 58 years (ranging from 9 to 83 years). The most common NHLM identified were from lung/thoracic primaries (n = 103; 55.1%) with adenocarcinoma being the most common type of lung primary (n = 91; 88%). Other tumours detected included carcinomas from breast (n = 34; 18.2%), gastrointestinal tract (n = 17; 9.1%), genitourinary tract (n = 13; 7%), Müllerian origin (n = 8; 4.3%), and head and neck (n = 6; 3.2%). Rarer NHLM encompassed 3.2% of BALs (n = 6). Conclusion: FOB-BAL is a useful tool for evaluating various pulmonary abnormalities in our cancer institute's patient population and a valuable method for detecting NHLM, which is critical to guide appropriate subsequent therapies.