Unveiling the Diagnostic Potential: A Comprehensive Review of Bronchoalveolar Lavage in Interstitial Lung Disease

Sindhu, Arman; Jadhav, Ulhas; Ghewade, Babaji; Wagh, Pankaj; Yadav, Pallavi

doi:10.7759/cureus.52793

Cited by 2 publications

(1 citation statement)

References 34 publications

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“…BAL is utilised in the diagnostic work up of ILD by sampling distal airways with flexible bronchoscope and 100-250 ml of sterile saline is instilled with an aim to obtain at least 30% of aspirate back. It has a potential role in the diagnostic work up in ILD and sarcoidosis [18][19][20] . A lymphocytosis of >15% with associated CD4/CD8 ratio of >3.5 provides specificity of 93 to 96% for the diagnosis of sarcoidosis 21 .…”

Section: Bronchoalveolar Lavage (Bal)mentioning

confidence: 99%

Diagnostic Techniques in Sarcoidosis-Past, Present and the Future

Ahmad,

Fahim

2024

MRAJ

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Introduction: Sarcoidosis has historically been a challenging disorder to diagnose secondary to its non-specific symptoms and multi-system nature of organ involvement. Since the description of Kviem test in 1941, the diagnostic investigations have evolved substantially over time. We have witnessed refinement of the procedures to detect granulomatous inflammation with increasing utilisation of image guided modalities and more recently Transbronchial Lung Cryo-biopsy with an acceptable diagnostic yield. Methods: In this review, we aim to describe the utility of diagnostic techniques over the decades and propose an algorithm to help General Physicians as well as Pulmonologists. We used search terms including Sarcoidosis, Diagnosis, Transbronchial as well as endobronchial biopsy, Ultrasound guided core biopsy, Endobronchial ultrasound, Transbronchial Lung Cryo-biopsy, Fine Needle Aspiration as well as peripheral lymph node biopsy. Results: There has been significant advancement in the diagnostic techniques with improvement in the diagnostic yield for histological confirmation of Sarcoidosis. clinical evidence and diagnostic utility of salient diagnostic investigations has been evaluated in this review. The description of diagnostic methods and clinical evidence is deliberately kept brief. Ultrasound guided core biopsy of cervical lymph nodes (even in the absence of palpable glands) should be considered as least invasive test in suspected cases of mediastinal sarcoidosis. Transbronchial Lung Cryo-biopsy is relatively recent development in the diagnostic pathway and is an advantageous tool when lung parenchymal abnormalities are coupled with lack or minimal mediastinal and or hilar adenopathy. Conclusion: We propose a diagnostic algorithm for patients with suspected Sarcoidosis. The choice of investigation should be decided following discussion in a multi-disciplinary meeting. In appropriate clinical/radiological setting and expertise, core biopsy of cervical lymph nodes should be considered the first line investigation as it may prevent the need for more invasive bronchoscopic procedures. However, in the absence of mediastinal/cervical lymphadenopathy, Cryobiopsy (if available) should be considered, in preference to more invasive thoracic surgical procedure (s) associated with higher morbidity and mortality.

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Section: Bronchoalveolar Lavage (Bal)mentioning

confidence: 99%

Diagnostic Techniques in Sarcoidosis-Past, Present and the Future

Ahmad,

Fahim

2024

MRAJ

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KL‑6, ET‑1 and S100A9 levels in patients with idiopathic pulmonary fibrosis and obstructive sleep apnea

Bouloukaki,

Michelakis,

Tsitoura

et al. 2024

Exp Ther Med

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Obstructive sleep apnea (OSA) and idiopathic pulmonary fibrosis (IPF) frequently coexist. Elevated levels of Krebs von den Lungen-6 (KL-6), endothelin-1 (ET-1) and S100 calcium-binding protein A9 (S100A9) have been observed in patients with IPF, suggesting their potential role as biomarkers for lung fibrosis. The aim of the present study was to measure the levels of KL-6, ET-1 and S100A9 in patients with IPF-OSA and to test the potential of these biomarkers as a characteristic OSA signature with diagnostic and prognostic potential for IPF. A total of 55 subjects with newly-diagnosed IPF participated in the present cross-sectional study. In addition to performing overnight attended polysomnography and pulmonary function tests, serum and bronchoalveolar lavage (BAL) levels of KL-6, along with serum levels of ET-1 and S100A9, were also assessed. A total of 15 patients with IPF and 40 patients with IPF-OSA were included. Age, sex, comorbidities and pulmonary function tests did not differ between the groups. Although there was no significant difference between groups in the levels of KL-6, ET-1 and S100A9 (P>0.05), the serum ET-1 levels tended to be elevated in patients with OSA-IPF compared with patients with IPF (1.78 vs. 1.07 pg/ml; P= 0.06). Additionally, a significant association was observed between serum KL-6 levels and the severity of IPF, and also between BAL KL-6 levels and nocturnal mean SaO 2 levels, even after taking into account factors such as obesity and smoking. S100A9 levels were associated with the oxygen desaturation index, even after adjustments for obesity, smoking and the gender-age-physiology index, only in the IPF-OSA group. Conclusively, the present findings suggested significant associations between serum ET-1, S100A9 and BAL KL-6 levels and specific OSA severity parameters in the IPF-OSA group. This evidence suggested that these molecules could serve as biomarkers for the identification of patients with IPF-OSA, offering a distinct OSA signature that has diagnostic and potential treatment value. Larger studies are crucial to substantiate the present findings and reinforce this hypothesis.

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Unveiling the Diagnostic Potential: A Comprehensive Review of Bronchoalveolar Lavage in Interstitial Lung Disease

Cited by 2 publications

References 34 publications

Diagnostic Techniques in Sarcoidosis-Past, Present and the Future

Diagnostic Techniques in Sarcoidosis-Past, Present and the Future

KL‑6, ET‑1 and S100A9 levels in patients with idiopathic pulmonary fibrosis and obstructive sleep apnea

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