Integrated approach to bronchoalveolar lavage cytology to distinguish interstitial lung diseases

Laura Bergantini; Miriana d'Alessandro; Paolo Cameli; Anna Perrone; Behar Cekorja; Bianca Boncompagni; Maria Antonietta Mazzei; Piersante Sestini; Elena Bargagli

doi:10.1016/j.ejim.2021.04.005

Integrated approach to bronchoalveolar lavage cytology to distinguish interstitial lung diseases

Eur J Intern Med. 2021 Jul:89:76-80. doi: 10.1016/j.ejim.2021.04.005. Epub 2021 Apr 28.

Authors

Laura Bergantini¹, Miriana d'Alessandro², Paolo Cameli², Anna Perrone², Behar Cekorja², Bianca Boncompagni², Maria Antonietta Mazzei³, Piersante Sestini², Elena Bargagli²

Affiliations

¹ Department of Medical Sciences, Surgery and Neurosciences, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy. Electronic address: laurabergantini@gmail.com.
² Department of Medical Sciences, Surgery and Neurosciences, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy.
³ Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.

PMID: 33931268
DOI: 10.1016/j.ejim.2021.04.005

Abstract

Background: Broncho-alveolar lavage (BAL) is a safe diagnostic procedure, useful for differentiating fibrotic lung disorders and for excluding malignancy and infection. A recent multicenter study demonstrated a new, relatively sensitive, and specific index called Bronchoalveolar Cytology Threshold (BCT), useful for distinguishing healthy individuals from patients with lung diseases.

Objectives: In our study, BCT was applied for the first time to the analysis of interstitial lung diseases (ILDs), investigating its potential for differential diagnosis. Combinations of BAL cells that improve diagnostic accuracy for ILDs were studied and are proposed.

Methods: A retrospective analysis of BAL samples was performed. We considered more than 1000 BAL samples from patients investigated for ILD, performed at Siena University Hospital. The samples enrolled for the study included 468 patients: 413 with and 55 without ILD. BAL was performed for diagnostic purposes in line with international guidelines. BCT were calculated according to available literature.

Results: Among ILDs, patients with fibrotic hypersensitivity pneumonitis, idiopathic pulmonary fibrosis (IPF) and sarcoidosis showed significantly lower BCTs than unclassified ILD. Asbestosis patients showed significantly lower BCTs than nonspecific interstitial pneumonia (NSIP), cryptogenic organizing pneumonia (COP), connective tissue disease related ILD (CTD-ILD), sarcoidosis and unclassified ILD patients. COP patients showed significantly higher BCT than IPF, f-HP and sarcoidosis. Moreover, COP patients were best distinguished by BCT.

Conclusion: The analysis of BAL features is currently included in the diagnostic algorithm of ILDs. BAL cell patterns and BCT index can provide useful information for distinguishing ILDs, reducing the need for invasive procedures. Integrated approaches to BAL analysis can improve the interpretation of results without further cost or loss of time.

Keywords: BAL cell threshold; Broncho-alveolar lavage cell count; Diagnosis; ILD.

MeSH terms

Bronchoalveolar Lavage
Bronchoalveolar Lavage Fluid
Humans
Idiopathic Pulmonary Fibrosis*
Lung Diseases, Interstitial* / diagnosis
Retrospective Studies