Bronchoalveolar lavage in fibrotic idiopathic interstitial pneumonias

Yon Ju Ryu, Man Pyo Chung, Joungho Han, Tae Sung Kim, Kyung Soo Lee, Eun Mi Chun, Sun Young Kyung, Sung Hwan Jeong, Thomas V. Colby, Hojoong Kim, O. Jung Kwon

Research output: Contribution to journalArticle

49 Scopus citations

Abstract

The purpose of this study was to assess the role of bronchoalveolar lavage (BAL) in differentiating usual interstitial peumonia (UIP) from non-specific interstitial pneumonia (NSIP) and in predicting the prognosis in fibrotic idiopathic interstitial pneumonia (IIP). A retrospective review of 122 patients (age 58±8 years, 70 male) with UIP (n = 87) and NSIP (n = 35) was carried out. Prior to surgical lung biopsy, all of them underwent BAL and high-resolution-computed tomography (HRCT) of the chest. Neutrophil count in BAL fluid was higher in UIP (7.0%) than NSIP (3.0%) (P = 0.027). In contrast, BAL lymphocyte count was significantly higher in NSIP (29.0%) than UIP (5.5%) (P < 0.0001). In 62 patients whose HRCT findings were atypical for UIP, BAL lymphocytosis was more frequently observed in NSIP (20/33) than UIP (4/29) (P < 0.001) and the absence of BAL lymphocytosis suggested a diagnosis of UIP rather than NSIP (odds ratio 12.7, P < 0.001). Pathologic diagnosis of NSIP was the only independent factor predicting a longer survival of our patients (median follow-up 21 months) (hazard ratio (HR) 0.035, P = 0.005). When NSIP was not included in the survival analysis, higher BAL lymphocyte count was the only independent predictor of a longer survival (HR 0.909, P = 0.029). BAL is an useful non-invasive tool in fibrotic IIP, not only for excluding a variety of specific non-IIP diseases but also for narrowing the differential diagnosis and predicting the prognosis in the absence of the histopathologic diagnosis.

Original languageEnglish (US)
Pages (from-to)655-660
Number of pages6
JournalRespiratory Medicine
Volume101
Issue number3
DOIs
StatePublished - Mar 2007

Keywords

  • Bronchoalveolar lavage
  • Idiopathic interstitial pneumonia
  • Non-specific interstitial pneumonia
  • Usual interstitial peumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Ju Ryu, Y., Pyo Chung, M., Han, J., Kim, T. S., Lee, K. S., Chun, E. M., Kyung, S. Y., Jeong, S. H., Colby, T. V., Kim, H., & Kwon, O. J. (2007). Bronchoalveolar lavage in fibrotic idiopathic interstitial pneumonias. Respiratory Medicine, 101(3), 655-660. https://doi.org/10.1016/j.rmed.2006.06.003