Clinical utility of bronchoalveolar lavage in pediatric cancer patients.
BACKGROUND
Pulmonary disease in the pediatric cancer patient continues to pose a difficult clinical dilemma. Bronchoalveolar lavage (BAL) is commonly utilized for the diagnosis of pulmonary complications in the immunocompromised child.


METHODS
We retrospectively reviewed 53 BAL procedures performed in pediatric cancer patients with pulmonary disease between 1988 and 1998 to determine the diagnostic and clinical utility of BAL. Patients who had undergone prior myeloablative therapy were excluded from analysis.


RESULTS
The majority of patients (83%) had an underlying diagnosis of acute leukemia or lymphoma. BAL yielded a specific diagnosis in 16 patients (30%), including 15 infections and 1 malignant infiltration. Medical management was altered in an additional 14 patients (26%) as a consequence of a negative BAL result. Severe but transient complications associated with the BAL procedure occurred in four patients (8%). Minor complications following the BAL occurred in 21 patients (40%) and included transiently increased oxygen requirement and anesthesia-related gastrointestinal complaints. The mortality from lung disease in this patient population was 7.5%.


CONCLUSIONS
Both positive and negative BAL results contribute to the management of pediatric cancer patients with pulmonary disease. The low incidence of significant complications associated with BAL and the high mortality rate in this patient population support the choice of BAL as an initial diagnostic test in pediatric cancer patients with pulmonary disease.
Park
Julie R
JR
Department of Pediatrics, Division of Pediatric Hematology/Oncology, Children's Hospital and Regional Medical Center, University of Washington Medical School, Seattle, Washington 98105, USA. ipark2@chmc.org
Fogarty
Shana
S
Brogan
Thomas V
TV
D000293:Adolescent; D018893:Bronchoalveolar Lavage; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000150:complications*; D008171:Lung Diseases / Q000175:diagnosis* / Q000209:etiology; D008223:Lymphoma / Q000150:complications*; D008297:Male; D009369:Neoplasms / Q000150:complications; D012189:Retrospective Studies; D012680:Sensitivity and Specificity