341 Limited Diagnostic Value of Bronchoalveolar Lavage, Bronchial Washing and Brushing Compared with EBUS-FNA and Transbronchial Biopsy in Lung Cancer: A Retrospective Study at a Single Teaching Hospital

Document Type

Conference Proceeding

Publication Date

3-23-2026

Publication Title

Lab Invest

Keywords

adult, aged, bronchoalveolar lavage fluid, bronchus, cohort analysis, conference abstract, cytology, diagnosis, diagnostic value, endobronchial ultrasonography, female, fine needle aspiration biopsy, human, lung cancer, lung lavage, lymphoma, major clinical study, male, middle aged, retrospective study, small cell carcinoma, teaching hospital, tracheobronchial toilet, transbronchial biopsy, ultrasound guided fine needle aspiration

Abstract

Disclosures: Khalid Shittu: None; Ali Rizk: None; Beena Ahsan: None; Qing Chang: None; Lisi Yuan: None; Nazila Azordegan: None; Ziying Zhang: None Background: Endobronchial ultrasound–guided fine-needle aspiration (EBUS-FNA) and transbronchial biopsy (TB) are well-established diagnostic tools for lung cancer. At our institution, these procedures are often accompanied by ancillary bronchoscopic techniques such as bronchoalveolar lavage (BAL), bronchial washing (BW), and bronchial brushing (BB). However, the diagnostic contribution of these additional specimens appears limited, and their use may increase cost without clear clinical benefit. This study evaluated the incremental diagnostic yield of BAL, BW, and BB when performed alongside EBUS-FNA and TB. Design: We conducted a retrospective cohort study of patients who underwent EBUS-FNA or TB with concurrent BAL, BW, or BB between January to August 2025. Only cases with a confirmed diagnosis of lung malignancy were included. The reference standard for malignancy was the final diagnosis established from surgical biopsy, surgical resection, or cytology specimens, and all cases were independently reviewed and confirmed by a second pathologist or by departmental consensus. Results: A total of 72 patients (age range, 47–89 years; mean age, 68.5 years) met inclusion criteria, including 64 cases of non-small cell carcinoma, 6 cases of small cell carcinoma, and 2 cases of malignant lymphoma. EBUS-FNA detected malignancy in 57 of 72 cases (79.2%), while TB performed in 60 patients, detected malignancy in 51 cases (85.0%). When combined, EBUS-FNA and TB achieved a malignancy detection rate of 97.2% (70 /72). In contrast, ancillary bronchoscopic cytology techniques demonstrated substantially lower yields. Among the cohort, 65 patients underwent BAL, 5 underwent BW, and 8 underwent BB. The malignancy detection rates were 15.4% (10/65) for BAL, 40.0% (2/5) for BW, and 25.0% (2/8) for BB. Importantly, all cases positive by BAL, BW, or BB were also positive by EBUS-FNA or TB, and no lung cancer case was diagnosed solely by these ancillary techniques. [Formula presented] Conclusions: Combined EBUS-FNA and TB achieved a 97.2% detection rate for lung cancer, markedly outperforming BAL, BW, and BB. Ancillary bronchoscopic cytology techniques provided minimal additional diagnostic value and may increase cost without improving case detection. These findings suggest that BAL, BW, and BB should not be routinely performed when EBUS-FNA and TB are available, supporting the prioritization of EBUS-FNA combined with TB as the primary diagnostic approach in suspected lung cancer.

Volume

106

Issue

3

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