Published ahead of print on February 26, 2009, doi:10.1164/rccm.200808-1313OC
© 2009 American Thoracic Society doi: 10.1164/rccm.200808-1313OC
Significance of Bronchoalveolar Lavage for the Diagnosis of Idiopathic Pulmonary Fibrosis1 Medical Faculty, University of Duisburg-Essen, and Department of Pneumology/Allergy, Ruhrlandklinik, Essen, Germany; 2 Radiology Unit, Klinikum Niederberg, Velbert, Germany; 3 Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan; and 4 General and Experimental Pathology, Ruhr-University, Bochum, Germany Correspondence and requests for reprints should be addressed to Ulrich Costabel, M.D., Ph.D., University of Duisburg-Essen, and Department of Pneumology/Allergy, Ruhrlandklinik Tueschener Weg 40, 45239 Essen, Germany. E-mail: ulrich.costabel{at}ruhrlandklinik.de Rationale: According to the 2002 ATS/ERS Consensus Classification, a confident diagnosis of idiopathic pulmonary fibrosis (IPF) without surgical lung biopsy is made with consistent clinical/physiological findings and the typical features on high-resolution computed tomography (HRCT). Bronchoalveolar lavage (BAL) and/or transbronchial biopsy, one of four major criteria in the 2000 ATS/ERS IPF Statement, was no more essential in the diagnostic algorithm of 2002 ATS/ERS Consensus Classification. Objectives: To evaluate the additional utility of BAL for the diagnosis of IPF. Methods: A total of 101 patients with suspected IPF on HRCT were studied. Twenty-seven patients were excluded because of lack of functional impairment (n = 20), an underlying condition causing fibrosis (n = 5), or a clinical history inconsistent with IPF (n = 2). The remaining 74 patients met all the criteria recommended in the 2002 ATS/ERS Consensus Classification for making a diagnosis in the absence of surgical biopsy. The final diagnosis was made with further examinations, including pathological analysis, in patients who showed inconsistent findings for IPF on BAL. Measurements and Main Results: A cut-off level of 30% for lymphocytes in BAL demonstrated a favorable discriminative power for the diagnosis of IPF. Six of the 74 patients (8%) showed a lymphocytosis of 30% or greater in BAL. Their final diagnoses were idiopathic nonspecific interstitial pneumonia (n = 3) and extrinsic allergic alveolitis (n = 3). The change in perception of the diagnosis was validated by a surgical biopsy in two cases and by subsequent outcome in four cases. Conclusions: BAL lymphocytosis changed the diagnostic perception in six of 74 patients who would have been misdiagnosed as having IPF without BAL.
Key Words: lymphocytosis • extrinsic allergic alveolitis • nonspecific interstitial pneumonia
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