Clinical Usefulness of Bronchoalveolar Lavage Cellular Analysis and Lymphocyte Subsets in Diffuse Interstitial Lung Diseases

Abstract

BackgroundDiffuse interstitial lung diseases (DILDs) form a part of a heterogeneous group of respiratory diseases. Bronchoalveolar lavage (BAL) analysis has been used for differential diagnosis of DILDs, but their clinical usefulness is controversial. The aim of this study was to investigate the clinical usefulness of BAL cellular analysis with lymphocyte subsets for the differential diagnosis of DILDs.MethodsA total of 69 patients diagnosed with DILDs were enrolled. Basic demographic data, BAL cellular analysis with lymphocyte subsets, histology, and high resolution computed tomogram (HRCT) findings were analyzed and compared as per disease subgroup.ResultsSignificant differences were found between groups in the proportion of neutrophils (P=0.0178), eosinophils (P=0.0003), T cells (P=0.0305), CD4 cells (P=0.0002), CD8 cells (P<0.0001), and CD4/CD8 ratio (P<0.0001). These findings were characteristic features of eosinophilic pneumonia and sarcoidosis. Other parameters were not significantly different between groups. At the cut-off value of 2.16 for sarcoidosis, CD4/CD8 ratio showed sensitivity of 91.7% (95% CI, 61.5-98.6%) and specificity of 84.2% (95% CI, 72.1-92.5%).ConclusionsRoutine analysis of BAL lymphocyte subset may not provide any additional benefit for differential diagnosis of DILDs, except for conditions where BAL is specifically indicated, such as eosinophilic pneumonia or sarcoidosis.

Usefulness of bronchoalveolar lavage and flow cytometry in patients with hematological malignancies and respiratory failure

“…20 In our study, the CD4/CD8 ratio was not predictive of infection. In diffuse interstitial lung diseases such as eosinophilic pneumonia and sarcoidosis the CD4/CD8 ratio may help in the differential diagnosis with other lung diseases.…”

Diversity of Human and Macaque Airway Immune Cells at Baseline and during Tuberculosis Infection

“…Previous studies of human BAL cells have used lymphocyte percentage and BAL CD4: CD8 T-cell ratios as basic measures of immune activity (37,38). Comparison of CD4:CD8 ratios in BAL of humans and macaques was confounded by the observation that DP T expressing both CD4 and CD8 were observed in BAL of macaques, but not of humans.…”

S2K-Leitlinie zur Diagnostik der idiopathischen Lungenfibrose

“…In den berücksichtigten Studien wurden in der BAL die Prozentsätze der Neutrophilen [78 -83, 85], der Alveolarmakrophagen [78 -82, 85], der Lymphozyten [78 -85] und der Eosinophilen [78, 80 -83, 85] sowie der CD4-/CD8-Quotient [78,80,82,83] bestimmt. Verglichen wurden die Daten von IPF mit anderen ILD-Diagnosen wie exogen allergische Alveolitis (EAA) [78,79,83], Sarkoidose [78,82,83], idiopathische NSIP [78,80,83,85], kryptogen organisierender Pneumonie (COP) [78 -80, 83], eosinophile Pneumonie [78], RB-ILD [79] sowie LIP [79]. In den meisten Arbeiten wurden die Zellverteilungen als Mittelwerte dargestellt, in einigen als Median.…”