title: Activated CD8(+) T cells and NKT cells in BAL fluid improve diagnostic accuracy in sarcoidosis.
abstract: OBJECTIVE
  The clinical diagnosis of pulmonary sarcoidosis is based on the presence of noncaseating granulomas in an appropriate clinical setting with either bilateral hilar adenopathy and/or parenchymal infiltrates. Lymphocytosis with an increased CD4/CD8 T cell ratio in bronchoalveolar lavage fluid is supportive. We evaluated the diagnostic accuracy of a predictive binary logistic regression model in sarcoidosis based on sex, age, and bronchoalveolar lavage fluid cell profile with and without the inclusion of HLA-DR(+) CD8(+) T cells and natural killer T-cell fractions.
  
  
  METHODS
  A retrospective analysis of differential cell counts and lymphocyte phenotypes by flow cytometry in bronchoalveolar lavage was performed in 183 patients investigated for possible diffuse parenchymal lung disease. A logistic regression model with age, sex, lymphocyte fraction, eosinophils, and CD4/CD8 ratio in bronchoalveolar lavage fluid (basic model) was compared with a final model, which also included fractions of HLA-DR(+) CD8(+) T cells and natural killer T cells. Diagnostic accuracy of the two models was assessed by receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  The area under the ROC curve for the basic and final model was 0.898 [95 % confidence interval (CI) 0.852-0.945] and 0.937 (95 % CI 0.902-0.972), respectively, p = 0.008.
  
  
  CONCLUSIONS
  Assessment of HLA-DR(+) CD8(+) T cell and natural killer T-cell fractions may improve diagnostic accuracy and further strengthen the importance of bronchoalveolar lavage in the diagnostic workup of sarcoidosis.
authors.affiliation: Department of Thoracic Medicine, St. Olavs Hospital, Postboks 3250 Sluppen, 7006, Trondheim, Norway, anders.tondell@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Tøndell
authors.forename: A D
authors.initials: AD
authors.lastname: Rø
authors.forename: A
authors.initials: A
authors.lastname: Åsberg
authors.forename: M
authors.initials: M
authors.lastname: Børset
authors.forename: T
authors.initials: T
authors.lastname: Moen
authors.forename: M
authors.initials: M
authors.lastname: Sue-Chu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000276:immunology*; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D002648:Child; D005260:Female; D005434:Flow Cytometry; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D016130:Immunophenotyping; D016015:Logistic Models; D008168:Lung / Q000276:immunology*; D008213:Lymphocyte Activation; D018655:Lymphocyte Count; D008218:Lymphocytosis / Q000175:diagnosis* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D055611:Natural Killer T-Cells / Q000276:immunology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis* / Q000276:immunology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006684:HLA-DR Antigens