Significance of lymphocytosis in bronchoalveolar lavage in suspected ocular sarcoidosis

Abstract

Ocular sarcoidosis is frequent in Japan, but in many cases the condition remains undiagnosed in patients with suspected ocular sarcoidosis. Bronchoalveolar lavage (BAL) was performed in order to study the clinical implications of lymphocytosis of BAL fluid in such patients with characteristic ocular manifestations.The subjects included in this study were 39 patients with suspected ocular sarcoidosis. The patients were divided into four types based on high-resolution computed tomography (HRCT) findings; no lung involvement (HRCT-0), bilateral hilar lymphadenopathy (BHL) without lung involvement (HRCT-I), lung involvement and BHL (HRCT-II), and lung involvement and no BHL (HRCT-III). Transbronchial lung biopsy (TBLB) and BAL were conducted after examining serum angiotensin-converting enzyme and serum lysozyme values, skin test for purified protein derivative chest radiograph, HRCT, and gallium scintigram.Twenty patients were histologically diagnosed as having sarcoidosis, and 19 patients remained undiagnosed. Granuloma was identified by TBLB in 19 of 20 patients in type HRCT-II but in only one of 19 patients in types HRCT-0 and HRCT-I (p<0.0001). Lymphocytosis in BAL (>15%) was identified in all patients who showed lung field involvement (type HRCT-II) and in 16 of 19 patients without lung field involvement (types HRCT-0 and HRCT-I). There were 10 patients whose only relevant findings were lymphocytosis in BAL. Among these 10 patients, an increased CD4+/CD8+ ratio (>3.5) in BAL was seen in 60%.The authors conclude that high-resolution computed tomography results yield the same degree of diagnostic accuracy as transbronchial lung biopsy in ocular sarcoidosis suspects. However, bronchoalveolar lavage revealed significant lymphocytosis in patients with negative high-resolution computed tomography results. It should be kept in mind that a diagnostic group of patients with sarcoidosis who manifest ocular involvement and lymphocytosis in bronchoalveolar lavage exists.

Does CT scanning predict the likelihood of a positive transbronchial biopsy in sarcoidosis?

“…However, it does show that both the extent of parenchymal disease and the distribution on the CT scan relative to the biopsy site can predict the likelihood of a positive TBB, with reticular and ground-glass patterns particularly associated with a positive biopsy result. Previous studies that have commented on CT appearances in relation to TBB yield have made little reference to the extent and distribution of parenchymal disease, albeit noting that parenchymal disease is often evident on the CT scan in those with stage 0–1 chest radiographs 9 10…”

Relevance of diagnostic investigations in patients with uveitis: Retrospective cohort study on 300 patients

“…Deux études françaises suggèrent que la biopsie des glandes salivaires accessoires, même si souvent pratiquée dans de nombreux centres, semble avoir une performance très limitée (sensibilité entre 3 et 5%) 14,15 . Enfin, la lymphocytose alvéolaire au lavage broncho-alvéolaire réalisé lors d'une fibroscopie bronchique semble également présenter un intérêt pour le diagnostic de sarcoïdose oculaire [16][17][18] . Cependant, aucune stratégie diagnostique n'a été validée dans une large étude intégrant les différents examens complémentaires potentiellement utiles pour le diagnostic étiologique des uvéites.…”

Bronchoalveolar Lavage and Sampling in Pulmonary Sarcoidosis

“…There may be a normal chest X-ray film, but conclusions from roentgenographic examination may underestimate the alveolitis already present. Moreover, typical sarcoid changes in BAL fluid samples can be found even without lung field involvement shown by high-resolution computed tomography, for example in patients with only ocular findings (ocular sarcoidosis) (Hoogsteden et al, 1988;Takahashi et al, 2001). Cigarette smoking modifies the immunologic BAL fluid sample profile and alveolitis is found to be less pronounced in smokers.…”