Bronchial Washings for Cytology Test

Cytology of pulmonary lesions provides valuable diagnostic information by non/minimally invasive procedures. It may be a valuable investigation in situations where biopsy procedure cannot be attempted due to high risk of haemorrhage. The cytological methods presently available for studying the lung pathology are exfoliative (induced sputum), abrasive cytology (bronchoalveolar lavage [BAL], bronchial brushing [BB], bronchial washing and percutaneous/endobronchial fine-needle aspiration cytology). Cell yield in a BB is better than aspirate and washing. However, wash technique samples out the areas beyond the reach of the brush. BAL was introduced as a therapeutic measure to clear alveolar spaces filled with secretion in alveolar proteinosis and bronchial asthma. It was later utilized for diagnostic pulmonary cytology providing a high accuracy rate. Bronchial wash cytology is a widely accepted safe, simple, and minimally invasive technique to evaluate cell morphology. The aim of this study was to evaluate the efficacy of bronchial wash cytology in the diagnosis of bronchopulmonary lesions and assess the role of morphometry in categorizing dysplastic/malignant lesions.

The cyto histopathological correlation was done in cases with biopsy. The cytological smears stained with May-Grünwald Giemsa and hematoxylin and eosin (H and E) were grouped into satisfactory/unsatisfactory and adequate/inadequate for interpretation. The satisfactory and adequate smears were further categorized as a normal pattern, inflammatory, suspicious/atypical favouring neoplasm, and positive for malignant cells. Adequate smears: Smears with bronchial epithelial cells/alveolar macrophage were considered adequate. Smears were considered satisfactory for reporting when there were no artifactual changes or excessive haemorrhage with blood elements obscuring cellular details. Exclusion criteria: Unsatisfactory and inadequate smears. Unsatisfactory smears: Smears were considered unsatisfactory based on the presence of degenerated/poorly preserved cell morphology, excessive haemorrhage with blood elements obscuring cellular details. Inadequate smears: Smears that lacked alveolar macrophages or epithelial cells.

It can be of value in patients with contraindication for biopsy. Morphometry can be a useful adjunct to cytomorphology, especially in situations where biopsy is contraindicated.

Bronchial washings or bronchoalveolar lavage (BAL) specimens obtained by physician not less than 1 to 2 mL for washings in 50 mL disposable centrifuge tube Washings or aspirates collected during the endoscopic examination should be collected and mixed with an equal volume of 50% ethyl alcohol or Saccomanno fixative. Specimens should be properly labelled and delivered immediately to the laboratory. Submit specimens in their original collection containers. (Note: Specimens prepared with fixatives that contain 50% ethyl alcohol, eg, Saccomanno fixative, are not acceptable for microbiology testing.) It should be refrigerated.