title: Induced sputum deposition improves diagnostic yields of pulmonary alveolar proteinosis: A clinicopathological and methodological study of 17 cases.
abstract: Pulmonary alveolar proteinosis (PAP) is a rare diffuse lung disease characterized by the accumulation of intra-alveolar lipoprotein-like surfactants. Lung core biopsy and bronchoalveolar lavage (BAL) fluid are currently the two major sources of sampling for diagnosis. In the present study, we assessed the value of induced sputum in diagnosing PAP by transmission electron microscopy and examined the PAP 2-year death rate in Asians. Transmission electron microscopy was performed on the samples from 17 patients with PAP, 13 patients with inflammatory lung diseases, and 13 healthy adults. The PAP patients were followed up for 3-156 months, and inflammatory lung diseases patients or healthy adults for 12-36 months. The ultrastructural features including diagnostic lamellar bodies of induced sputum deposition (ISD) samples were similar to that of the BAL fluid sediment. However, the rates of lamellar bodies were 73.7% in the ISD group, significantly higher than the spontaneous sputum deposition (SSD) group (42.1%, P < .0487) and similar to the BAL sediment (76.2%) and the lung biopsy (54.5%) groups. The overall 2-year death rate of our PAP patients was 17.6% (3/17), not statistically different from the healthy adults and patients with inflammatory diseases (0/13, P = .237 for both). ISD may be the preferred non-invasive sampling method for diagnosing PAP by electronic microscopy because of the higher diagnostic yield than SSD. The diagnostic yields of this noninvasive method were similar to that of lung core biopsy and BAL.
authors.affiliation: a Department of Pathology , Tongji Hospital, Tongji University School of Medicine , Shanghai , China.|b Department of Pathology , Labway Clinical Laboratory Shanghai Ltd ., Shanghai , China.
authors.forename: Ziling
authors.initials: Z
authors.lastname: Huang
authors.affiliation: a Department of Pathology , Tongji Hospital, Tongji University School of Medicine , Shanghai , China.
authors.forename: Xianghua
authors.initials: X
authors.lastname: Yi
authors.affiliation: c Department of Special Inspection , Shanghai Pulmonary Hospital, Tongji University School of Medicine , Shanghai , China.
authors.forename: Benfang
authors.initials: B
authors.lastname: Luo
authors.affiliation: b Department of Pathology , Labway Clinical Laboratory Shanghai Ltd ., Shanghai , China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhu
authors.affiliation: a Department of Pathology , Tongji Hospital, Tongji University School of Medicine , Shanghai , China.
authors.forename: Yunjin
authors.initials: Y
authors.lastname: Wu
authors.affiliation: d Department of Pathology , Tongji University School of Medicine , Shanghai , China.
authors.forename: Wenxia
authors.initials: W
authors.lastname: Jiang
authors.affiliation: e Department of Respiratory Medicine , Shanghai Pulmonary Hospital, Tongji University School of Medicine , Shanghai , China.
authors.forename: Haiqing
authors.initials: H
authors.lastname: Chu
authors.affiliation: f Department of Respiratory Medicine , Tongji Hospital, Tongji University School of Medicine , Shanghai , China.
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Yang
authors.affiliation: a Department of Pathology , Tongji Hospital, Tongji University School of Medicine , Shanghai , China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Li
authors.affiliation: a Department of Pathology , Tongji Hospital, Tongji University School of Medicine , Shanghai , China.
authors.forename: Hailong
authors.initials: H
authors.lastname: Zhu
authors.affiliation: a Department of Pathology , Tongji Hospital, Tongji University School of Medicine , Shanghai , China.
authors.forename: Suxia
authors.initials: S
authors.lastname: Zhang
authors.affiliation: g Department of Pathology , University Medical Center of Princeton , Plainsboro , NJ , USA.|h Department of Pathology and Laboratory Medicine , Rutgers Robert Wood Johnson Medical School , New Brunswick , NJ , USA.|i Department of Chemical Biology , Rutgers Ernest Mario School of Pharmacy , Piscataway , NJ , USA.|j Rutgers Cancer Institute of New Jersey , New Brunswick , NJ , USA.
authors.forename: Lanjing
authors.initials: L
authors.lastname: Zhang
authors.affiliation: a Department of Pathology , Tongji Hospital, Tongji University School of Medicine , Shanghai , China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zeng
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology* / Q000648:ultrastructure*; D008171:Lung Diseases / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D046529:Microscopy, Electron, Transmission / Q000379:methods; D008875:Middle Aged; D011649:Pulmonary Alveolar Proteinosis / Q000401:mortality / Q000473:pathology*; D013183:Sputum / Q000378:metabolism*
keywords: Bronchoalveolar lavage fluid; electron microscopy; induced sputum; pathology; pulmonary alveolar proteinosis; sputum