The Role and Associated Factors of Liquid-Based Cytology of Bronchoalveolar Lavage Fluid in Lung Cancer Diagnosis: A Prospective Study.

Background Liquid-based cytology (LBC) has shown advantages over conventional smears (CS), but previous applications in bronchoalveolar lavage (BAL) fluid have produced inconsistent results. This study compared LBC and CS for diagnosing lung cancer using BAL fluid. Methodology A prospective study was conducted on 92 patients suspected of having lung cancer. All patients underwent bronchoscopy and had a final diagnosis confirmed by histopathology of lesions tissue through biopsy. The study aimed to assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the two cytological methods, in a pair-wise fashion. In addition, the study evaluated the correlation of factors, such as the volume of fluid used in LBC and bronchoscopy lesion morphology, with the sensitivity of LBC. Results The study involved 78 participants who were diagnosed with lung cancer. The sensitivity, specificity, PPV, and NPV of LBC were 25.7%, 100%, 100%, and 19.4%, respectively, whereas those of CS were 15.4%, 85.7%, 85.7%, and 15.4%, respectively. Although the sensitivity of LBC was higher than that of CS, the difference was not statistically significant (p=0.096, McNemar test). Furthermore, the median fluid volume performed during LBC in patients with positive results was significantly higher than in those with negative results (p=0.001, Mann-Whitney U test). Conclusions The application of LBC to BAL fluid has demonstrated similar and potentially superior diagnostic accuracy compared to CS in detecting lung cancer. It is recommended that further investigation be undertaken to examine the relationship between the volume of fluid utilized during the LBC process and its diagnostic accuracy to enhance its sensitivity.

Central versus peripheral lesion on chest X-Ray: A case series of 31 endobronchial tuberculosis patients with negative sputum smears.

Background: Clinical characteristics of endobronchial tuberculosis (EBTB) patients whose sputum smears were negative have not been elucidated yet. Method: EBTB patients with negative sputum smears were documented retrospectively at the outpatient pulmonary clinic from late 2015 to early 2019. Results: We described the characteristics of 31 EBTB patients with negative sputum smears. The median age was 36 years (range 18-81 years). The male-to-female ratio is 1:1.58. The "peripheral" lesion group included 16 cases with opacity/consolidation, 2 cases with atelectasis, 1 case with cavitary lesion, and 1 case with pleural effusion. The "central" lesion group included four cases with normal chest X-ray and seven cases with only unilateral hilar enlargement. EBTB patients with "central" lesion were more common the presence of cough, the positive rate of bronchial lavage acid-fast bacilli smear, and the rate of misdiagnosis as pharyngitis, bronchitis, or asthma than that with "peripheral" lesion. Conclusions: EBTB with negative sputum smears was found in adult patients at any age and predominant in females. The diagnosis of EBTB with "central" lesion was more difficult than that with "peripheral" lesion. The location of the lesion could play a role in inducing cough among EBTB patients.

Model for predicting EGFR mutation status in lung cancer.

A predictive model using available chest CT images could better assess the presence of EGFR mutations. This model may also identify biopsy false-negative results . http://bit.ly/2MROmpe.

Hilar asymmetry in endobronchial tuberculosis patients: An often-overlooked clue.

BACKGROUND: Endobronchial tuberculosis (EBTB) is a challenging diagnosis because of its varied clinical and radiological manifestations. Hilar asymmetry on chest radiograph (CXR) may be found in patient with EBTB but is often overlooked, which may lead to delayed diagnosis. CASE REPORT: We present five cases with EBTB. Clinicians failed to identify unilateral hilar abnormalities on CXR, and these patients were treated initially for pharyngitis, bronchitis, or pneumonia with no improvement. Subsequently, they visited the pulmonary clinic and bronchoscopy revealed endobronchial lesions and microbial/histopathological evidence of tuberculous infection consistent with EBTB. Anti-tuberculosis therapy resulted in complete clinical resolution in four of the five patients; one patient had persistent bronchial stenosis. CONCLUSION: Hilar asymmetry on CXR may occur with EBTB and may suggest this diagnosis in the appropriate clinical setting. Bronchoscopy has an important role in establishing the final diagnosis.