Bronchoalveolar lavage in fibrotic idiopathic interstitial pneumonias.
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.
Ryu
Yon Ju
YJ
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongdaemun Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
Chung
Man Pyo
MP
Han
Joungho
J
Kim
Tae Sung
TS
Lee
Kyung Soo
KS
Chun
Eun-Mi
EM
Kyung
Sun Young
SY
Jeong
Sung Hwan
SH
Colby
Thomas V
TV
Kim
Hojoong
H
Kwon
O Jung
OJ
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