CYTOLOGY OF BRONCHOALVEOLAR LAVAGE FLUID IN THE INTERSTITIAL LUNG DISEASES
Abstract
Background. By the bronchoscopic lavaging we obtain cytological specimen of the peripheral airways and lung parenchyma. Bronchoalveolar lavage fluid (BALF) examination gives us information about inflammation in the interstitial lung diseases. BALF sampling and its laboratory processing are standardized in our hospital. Quality assurance practice requires that each institution establish disease characteristic BALF profiles. The aim of this study was to find common cytological characteristics of BALF specimens in sarcoidosis, extrinsic allergic bronchoalveolitis (EABA), asbestosis and idiopathic interstitial pneumonias (IIP).
Material and methods. We included 135 BALF specimens of good quality from patients with one of the mentioned entities that were diagnosed clinically, radiographically and pathologically. Based on diferential cell counts and lymphocytic phenotypisation done by immunofluorescence, BALF specimens were categorized as normal type, lymphocytic, neutrophilic, eosinophilic, macrophagic and mixed cell alveolitis. Statistical comparison was performed by the analysis of variance which was done by SAS software.
Results. BALF in sarcoidosis shown in 71% lymphocytic or mixed cell (lymphocytic and neutrophilic or eosinophilic) type alveolitis with increased CD4/CD8 ratio (> 3.5) in 61.4% specimens. EABA patients had lymphocytic or mixed cell (lymphocytic and neutrophilic or eosinophilic) type alveolitis in 53.3% of BALF specimens with decreased CD4/CD8 ratio (< 1) in 38.5% of specimens. Macrophagic alveolitis was the most common type found in asbestosis (52.9%). CD4/CD8 ratio was usually decreased or normal. Patients with IIP had all types of alveolitis and none of them prevailed, but neutrophils were increased often (53.3%). CD4/CD8 ratio was decreased in 65.5% of BALF specimens in IIP.
Conclusions. Sarcoidosis has the most characteristic BALF profile (CD4 lymphocytic alveolitis). We often see macrophagic alveolitis in asbestosis. BALF specimens in EABA and IIP have less characteristic profiles.
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