Bronchoalveolar Lavage in Sarcoidosis

Abstract

There is no single cell type present in bronchoalveolar lavage (BAL) fluid that appears to be predictive for sarcoidosis. However, BAL fluid analysis can be very helpful in the differential diagnosis. A grouping of features, an elevated total cell count, predominantly lymphocytes, together with a nearly normal percentage of eosinophils and polymorphonuclear neutrophils and the absence of plasma cells, distinguish the most likely diagnosis of sarcoidosis from the most common interstitial lung diseases, extrinsic allergic alveolitis (EAA), nonspecific interstitial pneumonia (NSIP), and idiopathic pulmonary fibrosis (IPF). In sarcoidosis the majority of cases have an increased number of lymphocytes and a normal amount of eosinophils and neutrophils. Disease presentation or activity at the time the BAL is performed as well as the smoking status is crucial for interpretation of individual BAL fluid analysis results. In severe cases the number of neutrophils can be increased as well. For an individual case the CD4:CD8 ratio is of less importance because it can be increased, normal, and even decreased. In the follow-up depicting prognosis and response to treatment, BAL fluid analysis has less clinical relevance.

Padrões tomográficos das doenças intersticiais pulmonares difusas com correlação clínica e patológica

“…(41) In addition, for a diagnosis of sarcoidosis, the sensitivity and specificity of a CD4/CD8 ratio > 3.5 in the BAL fluid are 52-59% and 94-96%, respectively. (42) A surgical lung biopsy from a patient with sarcoidosis is presented in noglobulin deficiency, Sjögren's syndrome, or mixed autoimmune disease with Sjögren's syndrome. (44,45) Amyloidosis Amyloidosis is a disorder of immunoglobulin protein folding in which normally soluble plasma proteins aggregate as an insoluble abnormal fibrillar form causing progressive disruption to tissue structure and organ function.…”

Role of Broncoalveolar Lavage in Diagnosis

“…The pathology may be similar to IPF with a usual www.intechopen.com interstitial pneumonia pattern, but many of the cases of CVD-associated pulmonary fibrosis show a pattern that is in the category of NSIP, based on a computed tomography scan or histology [26]. The BAL findings are also somewhat different from IPF.…”

“…However, in the late stage of sarcoidosis neutrophils may also be increased, as well as the number of mast cells. Patients with primary extrathoracic sarcoidosis may show typical findings of sarcoidosis on BAL even when imaging findings are normal [26]. The CD4/CD8 ratio also has high variability in sarcoidosis and approximately only 55% of www.intechopen.com patients show an increased CD4/CD8 ratio at the time of diagnosis.…”

Analysis of Inflammatory Cells with Immunuhistochemical Method in Bronchoalveolar Lavage Fluids of Sarcoidosis Patients

“…Sarkoidozlu hastalarda ilk saptanan BAL bulgusu, lenfosit sayısında artış olmasıdır. [17][18][19] BAL sıvısının incelenmesinde kullanı-lan metotlar, ışık mikroskobunda immün boyama ve akım sitometresidir. BAL sıvısında lenfosit alt gruplarının dağılımının incelenebilmesi için, lenfosit miktarının belli bir düzeyde olması gerekmektedir.…”

“…BAL sıvısında lenfosit alt gruplarının dağılımının incelenebilmesi için, lenfosit miktarının belli bir düzeyde olması gerekmektedir. 18,19 Bazı araştırıcılar, rutin mikroskobik çalışmada lenfosit sayısı total hücre sayısının %10'undan daha düşükse bu çalışmayı yapmamış-lardır. Akım sitometrisi kullanıldığı zaman ise len-…”