Performance of a standardized bronchoalveolar lavage protocol in a comprehensive cancer center: a prospective 2-year study.
BACKGROUND
Flexible bronchoscopy with bronchoalveolar lavage (BAL) is performed widely for the diagnosis of pulmonary infections in patients with cancer, but there is no consensus regarding the technical parameters of the lavage procedure in this setting.


METHODS
The authors evaluated the mechanics (instilled and recovered volumes), diagnostic yield, and safety of a standardized BAL protocol in 284 patients with cancer who underwent bronchoscopy for the evaluation of new radiologic infiltrates.


RESULTS
Physician adherence to the BAL protocol was > 90%. The most common protocol deviations were reductions in the saline volume instilled because of actual or anticipated oxyhemoglobin desaturation during the procedure. The mean volume instilled was 121.5 ± 13.9 mL, the mean volume recovered was 68.7 ± 18.1 mL, and the mean ratio of volume instilled to that recovered was 56.7% ± 14.5%. The overall diagnostic yield of BAL was 33.8% and was higher in the nonhematologic malignancy group (42.3% vs 29.4%; P = .021). The diagnostic yield in neutropenic patients was significantly higher than in non-neutropenic patients (41.5% vs 24.6%; P = .019). No major complications were encountered.


CONCLUSIONS
In summary, the diagnostic performance of a standardized BAL protocol was comparable to that of nonprotocolized BAL reported in the literature with few complications. Adherence to a standardized BAL protocol may improve clinical and laboratory comparisons between studies, potentially facilitating research into the diagnosis and management of pneumonia in patients with cancer.
Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, TX 77030-4009, USA.
Fotis
F
Sampsonas
Dimitrios P
DP
Kontoyiannis
Burton F
BF
Dickey
Scott E
SE
Evans
D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid; D002173:Cancer Care Facilities; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011446:Prospective Studies
Chest. 2004 Feb;125(2):712-22
14769756
Clin Infect Dis. 2004 Nov 15;39(10):1467-74
15546083
Clin Infect Dis. 2009 Dec 1;49(11):1688-93
19886801
Semin Respir Crit Care Med. 2007 Oct;28(5):546-60
17975782
Diagn Microbiol Infect Dis. 2002 Jun;43(2):99-105
12088615
Proc Am Thorac Soc. 2005;2(5):445-8
16322598
Clin Infect Dis. 2006 Sep 1;43(5):577-84
16886149
Clin Infect Dis. 2002 Feb 1;34(3):400-3
11774088
Bone Marrow Transplant. 2010 Apr;45(4):647-55
19684637
Thorax. 2001 May;56(5):379-87
11312407
Ann Hematol. 2009 Dec;88(12):1249-56
19415277
Expert Rev Anti Infect Ther. 2009 Dec;7(10):1151-3
19968505
Respir Med. 2006 Mar;100(3):529-35
16023336
Am Rev Respir Dis. 1990 Aug;142(2):481-6
2200319
Clin Infect Dis. 1997 Aug;25(2):247-59
9332520
Crit Care Med. 2008 Jan;36(1):100-7
18090351
Cancer. 2004 Jan 1;100(1):165-72
14692037
Eur J Haematol. 1995 Mar;54(3):157-62
7720835
Ann Hematol. 2008 Apr;87(4):291-7
17932672
Clin Infect Dis. 2002 Jan 1;34(1):7-14
11731939
Am Rev Respir Dis. 1985 Nov;132(5):1118-23
2998245
Clin Infect Dis. 2010 Feb 1;50(3):405-15
20047485
Crit Care. 2006 Feb;10(1):R31
16507158
Eur Respir J. 1989 Jun;2(6):561-85
2663535
BMC Infect Dis. 2010 Mar 03;10:44
20199673
Eur Respir J. 1999 Aug;14(2):245-8
10515395
Clin Infect Dis. 2007 Jul 15;45(2):228-33
17578784
Mycopathologia. 2007 Apr;163(4):191-202
17410480
Ann Hematol. 2003 Oct;82 Suppl 2:S118-26
13680172
Int J Hematol. 2007 Oct;86(3):225-32
17988988
J Clin Microbiol. 2006 Jul;44(7):2475-80
16825367
Chest. 2010 Feb;137(2):410-5
19801584