Usefulness of Carcinoembryonic Antigen Determination in Bronchoalveolar Lavage Fluid (7)Using both serum and BAL fluid CEA levels, the sensitivity increases to 88 percent, but the specificity decreases to 88 percent. Positive and negative predictive values were 66 percent and 96 percent, respectively.
When we add the CEA assay in BAL fluid to the results of the transbronchial biopsy (sensitivity: 55 percent), three new cases of cancer were detected and the sensitivity increased to 88 percent without changes in specificity. Positive and negative predictive values were 80 percent and 97 percent, respectively. Other studies, such as cytology in BAL fluid (positive in only 22 percent of the cases), does not improve the diagnostic yield.
Discussion
A peripheral lung mass is a common presentation of lung cancer. On several occasions, the mass produces a bronchial obstruction with subsequent peripheral pneumonitis that may obscure the presence of the tumor. In these cases, differential diagnosis with pneumonia is sometimes difficult.
There is a controversy whether fiberoptic bronchoscopy or transcutaneous needle aspiration is the first diagnostic procedure to be used in patients with suspected peripheral lung cancer; we prefer to use endoscopic methods when lung lesions are 2 cm or more in diameter because it allows us to carry out more complementary procedures such as transbronchial lung biopsy (TB) or bronchial brushing.