Significance of Imaging and Clinical Features in Pulmonary Lymphoma Diagnosed by Bronchoscopy

Background: Pulmonary lymphoma is rare while the radiographic lesions are nonspecific. The use of bronchoscopy, the first-line procedure, is controversial, and may be of limited diagnostic value for pulmonary lymphoma diagnosis. Methods: Cases of pulmonary lymphoma diagnosed by bronchoscopy were retrospectively reviewed from January 2010 till December 2020. Clinico-radiological records of these cases were retrieved and bronchoscopy was performed with histopathological evaluation of the biopsy specimens. Results: Of the 41 cases included in our study, 20 were primary pulmonary lymphoma. The majority of subtypes were diffuse large B-cell lymphoma(43.9%) and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue lymphoma(29.3%), with high percentage of underlying chronic disease. The common Computed Tomography(CT) abnormalities were mass(43.9%), consolidation(24.4%) or ground-glass opacities(24.4%). To evaluate the pulmonary lesions distribution, 41.5% patients had segmental lesions, 29.3% presences of diffuse lesions, 17.1% of local lesions and 12.2% of hilar lesions, with the maximal value of standard uptake value (SUVmax) median value of 9.6. At bronchoscopy, 41.5% lesions were identified as focal solitary mass, 22% were normal, 17.1% were mucosae asperity or edema, 9.8% were diffuse airway submucosal nodules or thickening and 9.8% were bronchiole stenosis, while certain endobronchial patterns may correspond to specific imaging features. Conclusions: Pulmonary lymphoma sometimes creates significant diagnostic dilemma for the clinicians, while the imaging features and endobronchial patterns are characteristic. Bronchoscopy is still a useful tool, that is minimally invasive, to diagnose pulmonary lymphoma, while accurate analysis of the clinico-radiological records is essential before such procedure.