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

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