Bronchoscopic diagnosis of pulmonary infiltrates in granulocytopenic patients with hematologic malignancies: BAL versus PSB and PBAL.
BACKGROUND
Treatment of patients with hematologic malignancies is often complicated by severe respiratory infections. Bronchoscopy is generally to be used as a diagnostic tool in order to find a causative pathogen.


OBJECTIVE
In a prospective study the combination of protected specimen brush (PSB) and protected bronchoalveolar lavage (PBAL) was compared with bronchoalveolar lavage (BAL) for evaluated feasibility and diagnostic yield in granulocytopenic patients with hematologic malignancies and pulmonary infiltrates.


METHODS
All specimens from 63 bronchoscopic procedures (35 BAL and 28 PSB-PBAL) were investigated by cytological examination and various microbiological tests. If clinically relevant and feasible, based on the clinical condition and/or the presence of thrombocytopenia, lung tissue samples were obtained.


RESULTS
The majority of the 58 included patients were diagnosed as having acute myeloid leukaemia and developed a severe neutropenia (BAL-group: 27 days; PSB-PBAL group: 30 days). Microbiological and cytological examination of 63 bronchoscopic procedures (35 BAL and 28 PSB-PBAL) yielded causative pathogens in 9 (26%) patients of the BAL-group and 8 (29%) patients of the PSB-PBAL group (PSB and PBAL 4 each). Aspergillus fumigatus was the pathogen most frequently (13%) detected. Using all available examinations including the results of autopsy, a presumptive diagnosis was established in 43% of the patients in the BAL group and 57% of those in the PSB-PBAL group; in these cases microbial aetiology was correctly identified in 67% and 57%, respectively. The complication rate was of these procedures were low, and none of the patients experienced serious complications due to the invasive techniques.


CONCLUSIONS
Our results showed that modern bronchoscopic techniques such as PSB and PBAL did not yield better diagnostic results compared to BAL in granulocytopenic patients with hematologic malignancies and pulmonary infiltrates. In approximately half of the cases a presumptive diagnosis was made by bronchoscopic procedures.
Boersma
Wim G
WG
Department of Pulmonary Diseases, Medical Center Alkmaar, 1800 AM Alkmaar, The Netherlands. w.boersma@mca.nl
Erjavec
Zoran
Z
van der Werf
Tjip S
TS
de Vries-Hosper
Hilly G
HG
Gouw
Annette S H
AS
Manson
Willem L
WL
D000328:Adult; D000368:Aged; D000380:Agranulocytosis / Q000150:complications / Q000382:microbiology* / Q000473:pathology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D001980:Bronchi / Q000382:microbiology / Q000473:pathology; D018893:Bronchoalveolar Lavage / Q000379:methods; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D019337:Hematologic Neoplasms / Q000150:complications / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000382:microbiology; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000382:microbiology / Q000473:pathology; D011014:Pneumonia / Q000150:complications / Q000382:microbiology / Q000473:pathology; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000382:microbiology*
D000900:Anti-Bacterial Agents