Chest, Vol 74, 150-156, Copyright © 1978 by American College of Chest Physicians

ARTICLES

The diagnostic value of lysosomal enzyme patterns in bronchial aspirates of patients with suspected bronchial carcinoma

SH Kuhn, MA de Kock and W Gevers

The measurement of the activity of acid hydrolases and of alkaline phosphatase in bronchial aspirates obtained through bronchoscopic procedures from a series of 300 patients forms the basis for a screening program to diagnose bronchial malignant neoplasms more effectively. We define such a screening test as one permitting rapid measurements indicative of pathologic abnormalities and producing a preliminary diagnosis which, if in error, yields preferably a false- positive result. Using this approach, we demonstrated that an elevation of the activity of alkaline phosphatase or cathepsin D predicts a 50 percent likelihood of cancer, but elevation of both the concentrations of alkaline phosphatase and cathepsin D has an additive prediction of 71 percent. Data obtained in this study showed that the presence of a pulmonary tumor can cause increased levels of alkaline phosphatase or cathepsin D (or both) in bronchial aspirates before the presently accepted methods yield a diagnostic result. Furthermore, those patients with an elevated activity of alkaline phosphatase or cathepsin D (or both) but with no histologically demonstrable pulmonary carcinoma can be reexamined intermittently.