Ann Lab Med.  2015 Mar;35(2):220-225. 10.3343/alm.2015.35.2.220.

Clinical Usefulness of Bronchoalveolar Lavage Cellular Analysis and Lymphocyte Subsets in Diffuse Interstitial Lung Diseases

• Lee W
• Chung WS
• Hong KS
• Huh J

• KMID: 2363182
• DOI: http://doi.org/10.3343/alm.2015.35.2.220

Abstract

BACKGROUND
Diffuse interstitial lung diseases (DILDs) form a part of a heterogeneous group of respiratory diseases. Bronchoalveolar lavage (BAL) analysis has been used for differential diagnosis of DILDs, but their clinical usefulness is controversial. The aim of this study was to investigate the clinical usefulness of BAL cellular analysis with lymphocyte subsets for the differential diagnosis of DILDs.
METHODS
A total of 69 patients diagnosed with DILDs were enrolled. Basic demographic data, BAL cellular analysis with lymphocyte subsets, histology, and high resolution computed tomogram (HRCT) findings were analyzed and compared as per disease subgroup.
RESULTS
Significant differences were found between groups in the proportion of neutrophils (P=0.0178), eosinophils (P=0.0003), T cells (P=0.0305), CD4 cells (P=0.0002), CD8 cells (P<0.0001), and CD4/CD8 ratio (P<0.0001). These findings were characteristic features of eosinophilic pneumonia and sarcoidosis. Other parameters were not significantly different between groups. At the cut-off value of 2.16 for sarcoidosis, CD4/CD8 ratio showed sensitivity of 91.7% (95% CI, 61.5-98.6%) and specificity of 84.2% (95% CI, 72.1-92.5%).
CONCLUSIONS
Routine analysis of BAL lymphocyte subset may not provide any additional benefit for differential diagnosis of DILDs, except for conditions where BAL is specifically indicated, such as eosinophilic pneumonia or sarcoidosis.

Keyword

Bronchoalveolar lavage; Lymphocyte subsets; Sarcoidosis; Pulmonary eosinophilia; Interstitial lung diseases

MeSH Terms

Aged
Aged, 80 and over
Area Under Curve
Bronchoalveolar Lavage Fluid/*cytology
CD4-CD8 Ratio
Demography
Eosinophils/cytology
Female
Humans
Immunophenotyping
Lung Diseases, Interstitial/*diagnosis/diagnostic imaging
Lymphocyte Subsets/*cytology
Male
Middle Aged
Neutrophils/cytology
ROC Curve
Sarcoidosis/diagnosis
T-Lymphocytes/cytology
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Post-hoc analysis of parameters between groups. (A) Neutrophil, (B) Eosinophil, (C) T cell, (D) CD4 cell, (E) CD8 cell, and (F) CD4/CD8 ratio. Post-hoc analysis between groups and statistical significance are shown. Eosinophil % showed a significant difference in the eosinophilic pneumonia group and CD4 cell %, CD8 cell %, and CD4/CD8 ratio in the sarcoidosis group.Abbreviations: See Table 1.

• 

  Fig. 2 Comparison of ROC curve for sarcoidosis (CD4, CD8, and CD4/CD8). The ROC curve for sarcoidosis diagnosis shows that the area under curve (AUC) was 0.918, 0.873, and 0.930 for CD4 cell %, CD8 cell %, and CD4/CD8 ratio, respectively, but no statistical difference was found among the variables (P>0.13). Based on the Youden index, cut-off of CD4/CD8 ratio for sarcoidosis was determined at 2.16, with sensitivity of 91.7% (95% CI, 61.5-98.6%) and specificity of 84.2% (95% CI, 72.1-92.5%).Abbreviations: TPF, true positive fraction; FPF, false positive fraction.

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