Beruflich Dokumente
Kultur Dokumente
September 2007
Acquisition of specimens
• Sputum
• BAL / Bronchial wash
• Bronchial brush
• Pleural fluid
• Needle biopsy
– Transbronchial
– Transesophogeal
– Transaortic
• Transthoracic FNA
Sputum
• Accuracy
– Patient is spontaneously producing sputum
– Vigorous sampling (3-5 early morning specimens)
– Preservation techniques
– Location and size of tumor
• Central (SCLC, SCC)
– Sensitivity:
• Sens 0.66, Spec 0.99 (average 16 studies)
• Prebronchoscopy
– suspected Lung Ca: sens 0.10-0.74 (8 studies)
• Central sens 0.71, Peripheral sens 0.49 (17 studies)
Sputum adequacy
• Numerous alveolar macrophages
• Patients with abnormal sputum cytology
should undergo bronchoscopy...
• Cells of bronchial cytology are
– Better preserved
– More numerous
– More cohesive
– Larger
– Lesions can be localized
– Cleaner background
Bronchoalveolar lavage
• Useful for
– Peripheral lesions
– Severe diffuse disease
– Evidence of inoperability
– Diagnosis of opportunisitc infections
– Interstitial lung disease
– Evaluation of transplant rejection
Evaluation
• Adequacy: bronchial cells,
abundant macrophages
• Keep your eyes peeled
for:
– Fungus
– Pneumocystis
– Viral inclusions
– Hemosiderin-laden
macrophages
– Atypical or malignant cells
Cues
• Lymphocytes
– Sarcoid
– Hypersensitivity pneumonia
• Drug reaction
• Neutrophils / Macrophages
– Idiopathic pulmonary fibrosis
– Cytotoxic drug reaction
– Langerhans histiocytosis
• Hemosiderin laden macrophages
– Occult pulmonary hemorrhage (not acute phase)
– Also associated with infection
Bronchial wash cells Bronchial brush cells
Glandular cells