The beryllium bronchoalveolar lavage lymphocyte proliferation test: indicator of beryllium sensitization, inflammation or both?
BACKGROUND
We had available records on over 300 workers evaluated with the beryllium bronchoalveolar lavage lymphocyte proliferation test (BeBALLPT) at three expert chronic beryllium disease (CBD) diagnostic centers.


OBJECTIVE
The objective was to describe the contribution of the BeBALLPT to classification of workers with respect to beryllium sensitization (BeS) and beryllium-induced lung inflammation.


METHODS
Company records were used to identify beryllium workers who had undergone diagnostic bronchoscopy with BeBALLPT. Clinical, work and smoking information was abstracted from electronic and paper databases. We analyzed factors influencing BeBALLPT outcome, and its relation to blood-determined BeS and granulomatous inflammation.


RESULTS
Positive BeBALLPTs contributed evidence of BeS in subjects without prior positive beryllium blood lymphocyte proliferation tests (BeBLPTs) and of pulmonary inflammation in persons without granulomata evident on lung biopsy. Positive BeBALLPTs were associated with positive BeBLPTs and more strongly with granulomata. The rate of both positive BeBALLPT and granulomata increased with time worked through 4 years and were lower in smoking subjects. The false negative rate of the BeBALLPT was 20%.


CONCLUSIONS
A positive BeBALLPT is closely linked to the presence of granulomata on lung biopsy and can be considered as an indicator of lung inflammation in addition to BeS. The ability to use BeBALLPT as a substitute for the more risky lung biopsy is limited by the BeBALLPT false negative rate and lack of information on the false positive rate. It is not recommended that a positive BeBALLPT be considered sufficient evidence for both lung inflammation and BeS.
Department of Environmental and.
Gregory H
GH
Heldt
David C
DC
Deubner
D000328:Adult; D000368:Aged; D000497:Alloys; D001608:Beryllium / Q000633:toxicity*; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D001999:Bronchoscopy; D049109:Cell Proliferation / Q000187:drug effects; D003300:Copper; D005260:Female; D015769:Granuloma, Respiratory Tract / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000175:diagnosis* / Q000473:pathology; D008214:Lymphocytes / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009532:Nickel; D016273:Occupational Exposure / Q000009:adverse effects; D011237:Predictive Value of Tests; D012130:Respiratory Hypersensitivity / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult
D000497:Alloys; D003300:Copper; D009532:Nickel; D001608:Beryllium
Beryllium inflammation; beryllium lymphocyte proliferation test; beryllium sensitization; bronchoalveolar lavage; chronic beryllium disease