International Journal of Current Research and Review
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IJCRR - 6(5), March, 2014

Pages: 43-47

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COMPARISON OF BRONCHOALVEOLAR LAVAGE CYTOLOGY AND BIOPSY IN LUNG MALIGNANCY

Author: Richa Sharma, Hemina Desai, Pankaj Malukani, R.N.Gonsai, H.M.Goswami

Category: Healthcare

Abstract:Background : Respiratory tract cytology is well established throughout the world as a vital diagnostic procedure in the evaluation of any patient with suspected lung malignancy and with the introduction of Flexible Fiberoptic Bronchoscopy, Bronchoalveolar Lavage is a popularly accepted tool for diagnosing lung cancer. Aims and Objestives : 1) To determine the efficacy of BAL cytological technique in diagnosing carcinoma of lung and correlating them with histopathological diagnosis by Bronchial Biopsy 2) To study the variation in the results with regards to different morphological types of lung malignancies. Material And Methods : A retrospective study was conducted at our tertiary care hospital. We selected 100 cases where bonchoalveolar lavage cytology samples as well as Bronchial Biopsy were taken. Samples were processed and reported as per the standard methods. Histopathological diagnosis by Bronchial Biopsy was considered as the \"Gold Standard.\" The samples were obtained by Flexible Fiber-optic Bronchoscopy done by the clinician. Result : Sensitivity of BAL was 42% and Specificity was 89.6%. Positive Predictive Value (86%) and Negative Predictive Value (48%), False Negative Index (60%) and False Positive Index (11%) were also calculated. Accuracy was 59%. Morphologically,44% were classified as poorly differentiated carcinoma, 28% were adenocarcinoma, 16% were squamous cell carcinoma and 12% were small cell carcinoma on BAL cytology. While on Bronchial Biopsy 29% were poorly differentiated carcinomas, 21% were adenocarcinoma,15% were squamous cell carcinoma and 15% were small cell carcinoma. Conclusion: Bronchoalveolar Lavage cytology is a good screening method for diagnosing lung malignancy as it is fairly sensitive and specific when compared with Bronchial Biopsy which is the \"Gold Standard\" method.

Keywords: BAL (Bronchoalveolar Lavage), Bronchial Biopsy, Lung cancer.

Full Text:

INTRODUCTION

Respiratory tract cytology is well established throughout the world as a vital diagnostic procedure in the evaluation of any patient with suspected lung malignancy1,2 . Flexible Fiberoptic Bronchoscopy with its extended visual range, excellent patient?s acceptance, low complication rate, and high diagnostic yield, provides a safe and effective means for making the diagnosis2 and sampling of suspected areas for cytology. Broncho-alveolar lavage (BAL) was originally developed as a therapeutic tool for pulmonary conditions like pulmonary alveolar proteinosis, cystic fibrosis and intractable asthma. Bleeding is always a concern when an airway lesion is biopsied. Pneumothorax occurs in 1-10% of cases of transbronchial biopsies (TBB). Bronchoalveolar lavage cytology is a minimally invasive method and has no absolute contraindications beyond those commonly associated with bronchoscopy. Application of BAL to the diagnosis of pulmonary malignancy was first reported in the early and mid-1980s and has since gained acceptance and steady popularity as a tool for diagnosing lung cancer.1,3,10-16 In this study our objective was to determine the efficacy of BAL cytological technique in diagnosing carcinoma of lung by correlating them with histopathological diagnosis by Bronchial Biopsy. We also aim to study the variation in the results with regards to different morphological types of lung malignancies.

MATERIAL AND METHODS

A retrospective study was conducted at our tertiary care hospital. We selected 100 cases where both Bonchoalveolar Lavage cytology as well as Bronchial Biopsy samples were taken. BAL cytology samples were obtained by Flexible Fiberoptic Bronchoscopy by the clinician. Smears were prepared after centrifugation and were stained as per routine protocol.4 Biopsy samples were processed by routine paraffin method followed by Hematoxylin and Eosin stain.5 For reporting, WHO Classification System was followed.6 Histopathological diagnosis by Bronchial Biopsy was considered as the “Gold Standard.”

RESULTS

All the patients who were diagnosed with lung malignancy were in the age group of 55 to 75 years and most of them were males. Out of 100 cases, 66 were diagnosed by Bronchial Biopsy as lung cancer. Rest of the cases showed non specific inflammatory or tuberculous lesions or no significant pathology. BAL cytology showed 25 True Positive cases and 34 True Negative cases, as confirmed by Biopsy. 4 cases were diagnosed as False Positive and 37 cases as False Negative by BAL. (Table 1). Thus, Sensitivity of BAL was 42%. And Specificity was 89.6%.Similarly Positive Predictive Value (86%) and Negative Predictive Value (48%), False Negative Index (60%) and False Positive Index (11%) of BAL were calculated. Accuracy of BAL was 59%. (Table 2). Out of 25 True Positive cases diagnosed by BAL, 11 (44%) were classified as Poorly Differentiated Carcinoma (Figure 1), 7(28%) were Adenocarcinoma(Figure 2), 4 (16%) were Squamous Cell Carcinoma(Figure 3) and 3 (12%) were Small Cell Carcinoma. While only 19 (29%) cases out of 66 positive Bronchial Biopsies, were labelled as Poorly Differentiated Carcinomas, 14 (21%) were Adenocarcinoma, 10 (15%) were Squamous Cell Carcinoma and 3 (15%) were Small Cell Carcinoma. (Table 3)

DISCUSSION

Lung cancer is currently the most frequently diagnosed and the most common cause of cancer mortality worldwide.6 Since cytological sampling by BAL technique relies mainly on cells „exfoliated? from the malignant lesion in the bronchial epithelium, the adequacy of its samples depends on several vital factors, especially a) the degree of differentiation of malignant growth; b) preservation of the morphology of cytological material obtained; and c) technical skill of the clinician who is retrieving the lavage fluid from the bronchus1 In our study of 100 cases suspected of lung malignancy 66 were actually diagnosed positive for malignancy. The mean age of positive cases for malignancy was 60 years in our study and majority were males which correlated with most other studies.2,3,7,8 (TABLE : 4) The sensitivity (42%), specificity (89.6), False Negative Index (60%) and False Positive Index (11%) and accuracy (59%) were comparable to a similar study done by Gaur DS et al in which sensitivity, specificity, False Negative Index, False Positive Index and Accuracy were 39.4%, 89.6%, 60.6%, 10.4%, 71.4% respectively.1 In general, less differentiated, anaplastic lesions have more loosely cohesive cells in comparison to well differentiated lesions. Thus such lesions exfoliate larger number of cells into the Bronchial cavity than the well differentiated lesions.1 In our study too poorly differentiated lesions (44%) exceeded all other types among True positive cases. Similar results were obtained by Gaur DS et al also.1 Squamous Cell Carcinoma (35%) was second most common type after Poorly Differentiated Carcinoma in Biopsy samples as against BAL in which Adenocarcinoma (28%) was the second most common morphological type detected. This is supported by the fact that Squamous Cell Carcinoma followed by Adenocarcinoma are the two most common morphological type of lung malignancy worldwide.7 Similar results were also noted by Poletti et al.9 Small Cell Carcinoma was the next morphological type in both BAL(12%) and Biopsy(15%) samples and results were comparable with Gaur DS et al1 (7.1% BAL, 19.7%Biopsy) and Firoozbakhsh SH et al3 (2/17=12% BAL, 6/47=13% Biopsy). Only one case of Carcinoid tumor was diagnosed in Biopsy which was given falsely negative by BAL cytology much similar to the study by Gaur DS et al.1

CONCLUSION

Considering its safety, Bronchoalveolar Lavage cytology is a good screening method for diagnosing lung malignancy as it is fairly sensitive and specific when compared with Bronchial Biopsy which is the “Gold Standard” method.

a

 

References:

REFERENCES

1. Gaur DS, Thapliyal NC, Kishore S, Pathak VP. Efficacy of Broncho-Alveolar Lavage and Bronchial Brush Cytology in Diagnosing Lung Cancers,Journal of Cytology 2007; 24 (2) : 73- 77

2. Tuladhar, Panth, Joshi. Comparative analyses of cytohistologic techniques in diagnoses of lung lesions, Journal of Pathology of Nepal (2011).Vol.1, 126-130

3. Shahram Firoozbakhsh, Enayat Safavi. Bronchoalveolar Lavage in the Assessment of Peripheral Lung Cancer, Tanaffos 2003; 2(7) : 7-10

4. Johnston WW, Elson CE. Respiratory tract. In: Bibbo M, editor. Comprehensive cytopathology. 2nd ed. Philadelphia: W.B.Saunders Company; 1997. p. 325-401.

5. Bancroft JD, Gamble M, editors. Theory and practice of histological techniques. 5th ed. New York: Churchill Living Stone; 2002.

6. Travis, W. D., Colby, T. V., Corrin, B., Shimosato, Y., and Brambilla, E. Histological typing of tumours of lung and pleura. In: L. H. Sobin (ed.), World Health Organization International Classification of Tumours, Ed. 3. New York: Springer-Verlag, 1999.

7. Husain AN, Kumar V. The Lung. In: Robbins and Cotran. Pathologic basis of disease. 7th ed. Philadelphia: W.B. Saunders Company; 2006. pp711-22.

8. Rosai and Ackerman?s, surgical pathology, 3rd edition, :Chapter 7:291-340.

9. Venerino Poletti, M.D.,Giovanni Poletti, M.D., Bruno Murer, M.D., Luca Saragoni, M.D.,and Marco Chilosi, M.D. Bronchoalveolar Lavage in Malignancy, Seminars In Respiratory And Critical Care Medicine/Volume 28, Number 5 2007 1

0. John D. Mina. Neoplasms of the lung in Braunwald et al.Harrison?s Principle of Internal Medicine 15th ed. United States of America. MC Graw Hill Inc 2001; 567-71.

11. Springmeyer SC, Hackman R, Carlson JJ, et al. Bronchoalveolar cell carcinoma diagnosed by Bronchoalveolar Lavage.Chest 1983;83:378–379Q48

12. Stover DE, Zaman MB, Hajdu SI, Lange M, Gold J,Armstrong D. Bronchoalveolar Lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann Intern Med 1984;101:1–7

13. Young JA, Hopkin JM, Cuthberston WP. Pulmonary infiltrates in immunocompromised patients: diagnosis by cytological examination of Bronchoalveolar Lavage fluid.J Clin Pathol 1984;37:390–397

14. Sestini P, Rottoli L, Gotti G, et al. Bronchoalveolar Lavage diagnosis of bronchiolo-alveolar carcinoma. Eur J Respir Dis1985;66:55–58

15. Rossi GA, Balbi B, Risso M, Repetto M, Ravazzoni C.Acute myelomonocytic leukemia: demonstration of pulmonaryinvolvement by Bronchoalveolar Lavage. Chest 1985;87:259–260

16. Weynants P, Cordier JF, Chapuis Collier C, et al. Primary immunocytoma of the lung: the diagnostic value of Bronchoalveolar Lavage. Thorax 1985;40:542–54

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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Best Article Award

A study by Dorothy Ebere Adimora et al. entitled \"Remediation for Effects of Domestic Violence on Psychological well-being, Depression and Suicide among Women During COVID-19 Pandemic: A Cross-cultural Study of Nigeria and Spain\" is awarded Best Article of Vol 14 issue 23
A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
A study by Saurabh Suvidha entitled \"A Case of Mucoid Degeneration of Uterine Fibroid with Hydrosalphinx and Ovarian Cyst\" is awarded Best article of Vol 14 issue 21
A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
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A Study by Pandya S. et al. entitled "Acute and 28-Day Repeated Dose Subacute Toxicological Evaluation of Coroprotect Tablet in Rodents" is awarded Best Article for Vol 14 issue 10
A Study by Muhammad Zaki et al. entitled "Effect of Hemoglobin Level on the Severity of Acute Bronchiolitis in Children: A Case-Control Study" is awarded Best Article for Vol 14 issue 09
A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
A Study by Divya MP et al. entitled "Non-Echoplanar Diffusion-Weighted Imaging and 3D Fiesta Magnetic Resonance Imaging Sequences with High Resolution Computed Tomography Temporal Bone in Assessment and Predicting the Outcome of Chronic Suppurative Otitis Media with Cholesteatoma" is awarded Best Article for Vol 14 issue 06
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A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
A Study by Amol Sanap et al. entitled "The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup" is awarded Best Article Award of Vol 13 issue 24
A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
A Study by Ashish B Roge et al. entitled "Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and It’s Degradation Products" is awarded Best Article of Vol 13 issue 21
A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
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A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
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A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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