title: Bronchoalveolar lavage in fibrotic idiopathic interstitial pneumonias.
abstract: The purpose of this study was to assess the role of bronchoalveolar lavage (BAL) in differentiating usual interstitial pneumonia (UIP) from non-specific interstitial pneumonia (NSIP) and in predicting the prognosis in fibrotic idiopathic interstitial pneumonia (IIP). A retrospective review of 122 patients (age 58+/-8 years, 70 male) with UIP (n=87) and NSIP (n=35) was carried out. Prior to surgical lung biopsy, all of them underwent BAL and high-resolution-computed tomography (HRCT) of the chest. Neutrophil count in BAL fluid was higher in UIP (7.0%) than NSIP (3.0%) (P=0.027). In contrast, BAL lymphocyte count was significantly higher in NSIP (29.0%) than UIP (5.5%) (P<0.0001). In 62 patients whose HRCT findings were atypical for UIP, BAL lymphocytosis was more frequently observed in NSIP (20/33) than UIP (4/29) (P<0.001) and the absence of BAL lymphocytosis suggested a diagnosis of UIP rather than NSIP (odds ratio 12.7, P<0.001). Pathologic diagnosis of NSIP was the only independent factor predicting a longer survival of our patients (median follow-up 21 months) (hazard ratio (HR) 0.035, P=0.005). When NSIP was not included in the survival analysis, higher BAL lymphocyte count was the only independent predictor of a longer survival (HR 0.909, P=0.029). BAL is an useful non-invasive tool in fibrotic IIP, not only for excluding a variety of specific non-IIP diseases but also for narrowing the differential diagnosis and predicting the prognosis in the absence of the histopathologic diagnosis.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongdaemun Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yon Ju
authors.initials: YJ
authors.lastname: Ryu
authors.forename: Man Pyo
authors.initials: MP
authors.lastname: Chung
authors.forename: Joungho
authors.initials: J
authors.lastname: Han
authors.forename: Tae Sung
authors.initials: TS
authors.lastname: Kim
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Lee
authors.forename: Eun-Mi
authors.initials: EM
authors.lastname: Chun
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Kyung
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Jeong
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Colby
authors.forename: Hojoong
authors.initials: H
authors.lastname: Kim
authors.forename: O Jung
authors.initials: OJ
authors.lastname: Kwon
mesh_terms: D018893:Bronchoalveolar Lavage / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D008218:Lymphocytosis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011658:Pulmonary Fibrosis / Q000175:diagnosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods