Bronchoalveolar Lavage Cell Populations in the Diagnosis of Sarcoidosis

Sarcoidosis- A Clinicoradiological Profile of 30 Patients

“…12 Winterbauer et al described that a ratio of 4.0 or greater distinguished 27 patients with sarcoidosis from 28 patients with other interstitial lung diseases with a sensitivity of 59% and a specificity of 96%. 63 Thomeer and Demedts compared 42 patients with sarcoidosis and 90 patients with other forms of diffuse lung disease and found that a CD4/CD8 ratio of greater than 4.0 had a sensitivity of 55% and a specificity of 94%. 64 These three studies reached similar conclusions: in patients with a clinical picture typical of sarcoidosis, an elevated CD4/CD8 ratio in BAL may prove diagnostic of sarcoidosis and obviate the need for confirmation by additional biopsy.…”

“…It is important to note that in the study of Winterbauer et al, transbronchial biopsy had a specificity of 89% for the distinction between sarcoidosis and other forms of diffuse lung disease and was thus not better than the CD4/CD8 ratio in this respect. 63 SP Kantrow et al reported that in pulmonary sarcoidosis BAL fluid CD4/CD8 ratio is highly variable and these authors found that only 42% in a population of 86 patients with biopsy-proven sarcoidosis had a ratio greater than 4.0, and that 12% had an inversed ratio below 1.0. 65 Danila E et al prospectively evaluated diagnostic role of BALF CD4/CD8 ratio in pulmonary sarcoidosis manifested in different radiographic and clinical forms and they found Normal BALF cell counts in 7% of sarcoid patients.…”

Staging of idiopathic pulmonary fibrosis

“…Regarding CD4/CD 8 ratio, acute HP is usually decreased. On the other hand that is elevated for CHP and sarcoidosis (34). In BALF eosinophilia, eosinophilic pneumonia or drug associated ILD is possible (35).…”

Diagnostic approach to interstitial lung disease

“…A prominent BAL lymphocytosis may also be present in COP, cellular NSIP, lymphoid interstitial pneumonia (LIP), drug toxicity or non-LIP lymphoproliferative disorders. Furthermore, an elevated CD4+/ CD8+ ratio of 3.5 is relatively specific for active sarcoidosis [32,33], but the sensitivity is low and the ratio increases in elderly patients [34]. Thus, use of the CD4+/CD8+ ratio as a routine component of BAL analysis is questionable and may increase the cost of the procedure considerably.…”