BAL Fluid Cellular Analysis and Radiologic Patterns in Patients With Fibrotic Interstitial Lung Disease

被引：0

作者：

Grant-Orser, Amanda ^{[1
,21
]}

Asmussen, Michael ^{[2
]}

Marinescu, Daniel-Costin ^{[3
,4
]}

Hague, Cameron J. ^{[5
,6
]}

Muller, Nestor L. ^{[5
,6
]}

Murphy, Darra T. ^{[7
]}

Churg, Andrew ^{[8
]}

Wright, Joanne L. ^{[8
]}

Al-Arnawoot, Amna ^{[9
]}

Bilawich, Ana-Maria ^{[3
]}

Bourgouin, Patrick ^{[10
]}

Cox, Gerard ^{[11
]}

Durand, Celine

Elliot, Tracy ^{[12
]}

Ellis, Jennifer ^{[5
,6
]}

Fisher, Jolene H. ^{[13
]}

Fladeland, Derek ^{[14
]}

Goobie, Gillian C. ^{[3
,4
,15
]}

Guenther, Zachary ^{[12
]}

Haider, Ehsan ^{[9
]}

Hambly, Nathan ^{[11
]}

Huynh, James ^{[12
]}

Karjala, Geoffrey ^{[14
]}

Khalil, Nasreen ^{[3
]}

Kolb, Martin ^{[11
]}

Leipsic, Jonathon ^{[5
,6
]}

Lok, Stacey ^{[16
]}

Macisaac, Sarah ^{[11
]}

Mcinnis, Micheal ^{[17
,18
]}

Manganas, Helene ^{[19
]}

Marcoux, Veronica ^{[16
]}

Mayo, John ^{[5
,6
]}

Morisset, Julie ^{[19
]}

Scallan, Ciaran ^{[11
]}

Sedlic, Tony ^{[5
,6
]}

Shapera, Shane ^{[13
]}

Sun, Kelly ^{[13
]}

Tan, Victoria ^{[11
]}

Wong, Alyson W. ^{[3
,4
]}

Zheng, Boyang ^{[20
]}

Ryerson, Christopher J. ^{[3
,4
]}

Johannson, Kerri A. ^{[1
,21
]}

机构：

[1] Univ Calgary, Dept Med, Calgary, AB, Canada

[2] Vancouver Isl Univ, Dept Kinesiol, Nanaimo, BC, Canada

[3] Univ British Columbia, Dept Med, Vancouver, BC, Canada

[4] St Pauls Hosp, Ctr Heart Lung Innovat, Vancouver, BC, Canada

[5] Vancouver Gen Hosp, Dept Radiol, Vancouver, BC, Canada

[6] Univ British Columbia, Vancouver, BC, Canada

[7] St James Hosp, Dept Radiol, Dublin, Ireland

[8] Univ British Columbia, Vancouver Gen Hosp, Dept Pathol, Vancouver, BC, Canada

[9] McMaster Univ, Dept Radiol, St Josephs Healthcare, Hamilton, ON, Canada

[10] Univ Montreal, Dept Radiol Radiat Oncol & Nucl Med, Montreal, PQ, Canada

[11] McMaster Univ, Dept Med, Hamilton, ON, Canada

[12] Univ Calgary, Dept Radiol, Calgary, AB, Canada

[13] Univ Toronto, Dept Med, Toronto, ON, Canada

[14] Univ Saskatchewan, Dept Med Imaging, Saskatoon, SK, Canada

[15] Univ Pittsburgh, Dept Med, Pittsburgh, PA USA

[16] Univ Saskatchewan, Dept Med, Saskatoon, SK, Canada

[17] Dept Med Imaging Univ Toronto, Dept Med Imaging, Toronto, ON, Canada

[18] Univ Med Imaging Toronto, Toronto Gen Hosp, Toronto, ON, Canada

[19] Univ Montreal, Dept Med, Montreal, PQ, Canada

[20] McGill Univ, Div Rheumatol, Montreal, PQ, Canada

[21] Univ Calgary, Snyder Inst Chron Dis, Calgary, AB, Canada

来源：

CHEST | 2025年 / 167卷 / 01期

关键词：

BAL; bronchoscopy; guidelines; interstitial lung disease; radiologic patterns; IDIOPATHIC PULMONARY-FIBROSIS; BRONCHOALVEOLAR LAVAGE; DIAGNOSIS; UPDATE;

D O I：

10.1016/j.chest.2024.07.166

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND: BAL cellular analysis is often recommended during the initial diagnostic evaluation of fibrotic interstitial lung disease (ILD). Despite recommendation for its use, between- center heterogeneity exists and supportive data concerning the clinical utility and correlation of BAL findings with radiologic features or patterns remain sparse. RESEARCH QUESTION: In patients with fibrotic ILD, are BAL findings associated with radio- logic features, patterns, and clinical diagnoses? STUDY DESIGN AND METHODS: Patients with fibrotic ILD who underwent BAL for diagnostic evaluation and who were enrolled in the prospective Canadian Registry for Pulmonary Fibrosis were re-reviewed in a standardized multidisciplinary discussion (MDD). BAL was categorized according to guideline-recommended thresholds, and using thresholds of lymphocytosis > 20% and neutrophils > 4.5%. High-resolution CT (HRCT) scans were scored (anonymized to clinical data) for specific features and percentage lung involvement. Radiologists classified HRCT scans according to guideline-defined patterns for idiopathic pulmonary fibrosis and fibrotic hypersensitivity pneumonitis; then, MDD diagnoses were assigned, considering all available data. RESULTS: Bronchoscopy with cellular analysis was performed in 209 of 1,593 patients (13%). Lymphocyte % was weakly negatively correlated with total fibrosis % (r = -0.16, P = .023) but not statistically significantly correlated with ground glass opacity % (r = 0.01, P = .94). A mixed BAL pattern was the most frequent in all radiologic patterns (range, 45%-69%), with a minority classifiable according to BAL guidelines. BAL lymphocytosis appeared with similar frequency across HRCT patterns of fibrotic hypersensitivity pneumonitis (21%) and usual interstitial pneumonia (18%). Only 5% of patients with MDD-based fibrotic hypersensitivity pneumonitis had a guideline-defined isolated lymphocytosis > 15%. INTERPRETATION: BAL cellular analyses did not significantly correlate with radiologic features, guideline patterns, or MDD-based diagnoses. Ground glass opacities are often interpreted to represent pulmonary inflammation, but were not associated with BAL lymphocytosis in this cohort. CHEST 2025; 167(1):172-182

引用

页码：172 / 182

页数：11

共 50 条

[1] Organic Exposures, Radiologic Features, and Patterns in Fibrotic Interstitial Lung Disease
Lok, Stacey D.
Marinescu, Daniel-Costin
Marcoux, Veronica
Kolb, Martin
Fisher, Jolene H.
Shapera, Shane S.
Morisset, Julie
Manganas, Helene
Ryerson, Christopher J.
Johannson, Kerri A.
ANNALS OF THE AMERICAN THORACIC SOCIETY, 2024, 21 (08) : 1216 - 1218
[2] Bronchoalveolar Lavage Fluid and Radiographic Patterns in Patients With Fibrotic Interstitial Lung Disease
Grant-Orser, A.
Asmussen, M.
Marinescu, D.
Hague, C.
Muller, N.
Murphy, D.
Churg, A. M.
Wright, J. L.
Al-Arnawoot, A.
Bilawich, A.
Bourgouin, P.
Cox, G. P.
Durand, C.
Elliot, T.
Ellis, J.
Fisher, J. H.
Fladeland, D.
Goobie, G. C.
Guenther, Z.
Haider, E.
Hambly, N.
Huyhn, J.
Karjala, G.
Khalil, N.
Kolb, M. R.
Leipsic, J.
Lok, S. D.
Macisaac, S.
McInnis, M.
Manganas, H.
Marcoux, V.
Mayo, J.
Morisset, J.
Scallan, C. J.
Sedlic, T.
Shapera, S.
Sun, K.
Sun, K.
Tan, V.
Wong, A. W.
Zheng, B.
Ryerson, C. J.
Johannson, K. A.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2023, 207
[3] Organic and Inorganic Exposures Are Associated With Radiologic Features in Patients With Fibrotic Interstitial Lung Disease
Lok, S. D.
Marinescu, D.
Hague, C.
Muller, N.
Bilawich, A.
Mayo, J.
Sedlic, T.
Ellis, J.
Murphy, D.
Leipsic, J.
Churg, A. M.
Wright, J. L.
Al-Arnawoot, A.
Haider, E.
Tan, V.
Bourgouin, P.
Durand, C.
Elliot, T.
Guenther, Z.
Huynh, J.
Fladeland, D.
Karjala, G.
McInnis, M.
Grant-Orser, A.
Goobie, G. C.
Khalil, N.
Cox, G. P.
Hambly, N.
Kolb, M. R.
Scallan, C. J.
Macisaac, S.
Marcoux, V.
Manganas, H.
Morisset, J.
Shapera, S.
Fisher, J. H.
Sun, K.
Zheng, B.
Wong, A. W.
Ryerson, C. J.
Johannson, K. A.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2023, 207
[4] Bronchoalveolar Lavage (BAL) Fluid Cytokine and Chemokine Analysis in Interstitial Lung Disease (ILD)- Can It Predict Progressive Fibrotic Phenotype?
Iannazzo, N.
Koehler, Z.
Twigg, H. L.
Smith, P.
Bawa, A.
Boente, R.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2023, 207
[5] Significance of BAL fluid findings as a diagnostic tool in patients with interstitial lung disease
Nagai, S
Mikuniya, T
Kitaichi, M
Shigematsu, M
Hamada, K
Nagao, T
Mio, T
Hoshino, Y
Miki, H
Izumi, T
BRONCHOLOGY AND BRONCHOESOPHAGOLOGY: STATE OF THE ART, 2001, 1217 : 114 - 117
[6] Oxidized BAL fluid proteins in patients with interstitial lung diseases
Lenz, AG
Costabel, U
Maier, KL
EUROPEAN RESPIRATORY JOURNAL, 1996, 9 (02) : 307 - 312
[7] Microbiology profile of BAL in interstitial lung disease patients
Palmer, E.
Nagy, A.
Nagy, T.
Toth, N.
Polivka, L.
Vincze, K.
Eszes, N.
Bohacs, A.
Muller, V.
EUROPEAN RESPIRATORY JOURNAL, 2022, 60
[8] The Impact of Frailty on Prescribing Patterns and Medication Tolerability in Patients With Fibrotic Interstitial Lung Disease
Wong, A. W.
Marinescu, D.
Cox, G. P.
Durand, C.
Fisher, J. H.
Grant-Orser, A.
Goobie, G. C.
Hambly, N.
Johannson, K. A.
Khalil, N.
Kolb, M. R.
Lok, S. D.
Macisaac, S.
Manganas, H.
Marcoux, V.
Morisset, J.
Scallan, C. J.
Shapera, S.
Sun, K.
Zheng, B.
Ryerson, C. J.
Guler, S. A.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2024, 209
[9] Sleep Characteristics in Patients with Fibrotic Interstitial Lung Disease
Myall, K.
Simpson, T.
West, A.
West, A.
Kent, B. D.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2020, 201
[10] Workplace Productivity in Patients with Fibrotic Interstitial Lung Disease
Algamdi, M.
Sadatsafavi, M.
Fisher, J. H.
Morisset, J.
Johannson, K. A. M.
Fell, C. D.
Kolb, M.
Manganas, H.
Cox, G.
Gershon, A. S.
Halayko, A. J.
Hambly, N.
Shapera, S.
To, T.
Khalil, N.
Wilcox, P. G.
Ryerson, C. J.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2018, 197

← 1 2 3 4 5 →