Bronchioloalveolar lavage in the diagnosis of CMV pneumonitis in lung transplant recipients: an immunocytochemical study.
Cytomegalovirus (CMV) pneumonitis is a common opportunistic infection in lung transplant recipients. Its diagnosis usually rests on the identification of viral inclusions in lung parenchyma obtained by transbronchial biopsy, or by examination of the cytologic material obtained by bronchioloalveolar lavage (BAL). To determine whether the use of immunocytochemistry (ICC) increases the sensitivity of cytology in the diagnosis of CMV pneumonitis, we retrospectively selected 17 cases in which transbronchial biopsy and BAL were performed simultaneously, and had positive histology with negative cytology. Five negative controls were selected. The 22 slides were decolorized and restained with ICC for CMV. Of the 17 slides, nine (53%) showed cells with positive nuclear staining. All controls were negative. These results were then correlated with the number of infected cells present in the biopsy tissue, and the location of the cells (interstitial vs. intraalveolar). A good correlation was found between positive cytology and intraalveolar location of infected cells, and no correlation was seen between number of infected cells in the biopsy and the positive cytology. In summary, although histologic evaluation of lung parenchyma obtained by transbronchial biopsy is more sensitive for diagnosis of CMV pneumonitis, the sensitivity of the cytologic evaluation of BAL material can be increased by the use of ICC. The likelihood of positive ICC seems to be related to the presence of infected cells in the alveolar space rather than to the number of infected cells.
Solans
E P
EP
Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA.
Yong
S
S
Husain
A N
AN
Eichorst
M
M
Gattuso
P
P
D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D016040:Lung Transplantation; D011024:Pneumonia, Viral / Q000175:diagnosis / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity