The utility of bronchoscopy in immunocompromised patients: a review

Abstract

Bronchoscopy is an important tool for the diagnosis of pulmonary disorders in immunocompromised patients. The addition of biopsies to bronchoalveolar lavage improves the diagnostic yield of non-infectious etiologies, although the underlying etiology of the immunocompromised state must be considered and may be influential. Certain unknowns remain, including timing of bronchoscopy and its impact on medical management and mortality. The ongoing role of non-invasive testing for infectious complications prior to bronchoscopy also remains to be defined. This review addresses the role of bronchoscopy in immunocompromised states related to underlying hematologic malignancies, prescription drug use or chemotherapy, and other disorders that predispose patients to infectious or non-infectious pulmonary diseases.

The Diagnostic Utility and Clinical Implications of Bronchoalveolar Lavage in Cancer Patients With Febrile Neutropenia and Lung Infiltrates

“…This retrospective study reports an appreciable diagnostic culture yield of BAL for patients with FN and lung infiltrates (44%), with minimal complication risks. The findings are comparable to previous studies in terms of diagnostic yield and safety [6][7][8][9][10][11]. The cumulative mortality in our study was 26.7%, however, the study elaborates that complications directly attributable to bronchoscopy were minimal.…”

“…The predominant etiology of pneumonias was determined to be bacterial in our setting (fungal in ICU). Precedent studies largely report fungal etiologies [6], while studies reporting bacterial predominance are sparse [22]. This finding seems to suggest that institutional and local studies on etiology of pneumonia, both in ICU and non-ICU settings, are essential to improve antibiotic stewardship, and establish the relevance of our study.…”

“…Nevertheless, an early etiological diagnosis is pivotal to improving overall management and outcomes. Bronchoalveolar lavage (BAL) using flexible bronchoscopy (FB) is regarded as a reliable diagnostic tool in patients with FN having lung infiltrates, with a reported diagnostic yield of around 22-65% and minimal complication risk [6][7][8][9][10][11][12].…”

Con: Bronchoscopy is essential for pulmonary infections in patients with haematological malignancies

“…Furthermore, diagnostic yield may correlate with anatomic location of pulmonary infiltrates and may also be higher in patients who are symptomatic and febrile compared with those who are asymptomatic [ 1 ]. Sampling techniques such as transbronchial lung biopsy or brushings combined with BAL improve diagnostic rates but need to be balanced against increased complication rates [ 15 ].…”

“…There is a paucity of clinical trials that examine the diagnostic yield of bronchoscopy in haematological malignancies and pulmonary infiltrates. Most of the evidence is retrospective, and the overall diagnostic yield of bronchoscopy varies widely from 23% to 65% due to a combination of patient heterogeneity, sampling techniques and timing [1,[15][16][17][18].…”