*Purpose: The role of cytologic evaluation in the diagnosis of acute allograft dysfunction has been described. Specific changes in cell count of bronchoalveolar lavage during acute lung rejection have been identified. ¹However, the role of cytology in the diagnosis of malignancy and infections remains controversial. Previous studies suggest that cytology may be more effective in diagnosing candida species and herpes simplex virus but not cytomegalovirus. ² Here we aim to determine the diagnostic value of cytology in bronchoalveolar lavages of patients who underwent lung transplantation.

*Methods: This is a retrospective cohort study of consecutive patients who underwent lung transplant at a large medical center in Southern California between 2018 and 2021. All cytology reports available were reviewed and findings of malignant cells, pneumocystis, viral changes, and fungal elements were recorded. Additionally, correlation between fungal elements on cytology and the presence of documented positive fungal culture in bronchoalveolar lavage on the same sample was queried.

*Results: A total of 89 cytology reports were found. None of the reports revealed malignant cells, viral changes, or pneumocystis. Thirty-three reports showed fungal elements. The most common fungal element was budding yeast consistent with candida followed by aspergillus species. When compared against a positive fungal culture, the presence of fungal elements in cytology yielded a sensitivity of 58% and a specificity of 75%.

Table 1: Summary of cytology findingsTable 2: Relationship between presence of fungal elements in cytology and microbiologic evidence of fungal pneumonia

*Conclusions: Based on our review, cytology has a very low yield to detect malignancy, viral changes, or pneumocystis infection. Furthermore, when compared against fungal cultures, the presence of fungal elements has a very low sensitivity and low specificity.

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