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A Journal on Internal Medicine

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Panminerva Medica 2002 September;44(3):257-60

language: English

Reliability of bronchoalveolar lavage in the routine clinical assessment of patients with sarcoidosis. A retrospective analysis

Marruchella A., Tondini M. *

Division of Pneumology, Civic Hospital, Piacenza, Italy
*Division of Pneumology, Hospital of Esine (BS), Italy


Background. The aim of the ­study was to eval­uate the reli­ability of bron­choal­ve­olar ­lavage in the rou­tine clin­ical assess­ment of ­patients ­with sar­coi­dosis.
Methods. Study ­design: ret­ro­spec­tive anal­ysis. Setting: 2 Divisions of Respiratory Medicine, ­both in the con­text of a ­public gen­eral hos­pital (Ospedale Morelli, Sondalo, Italy and Ospedale Civile, Piacenza, Italy). Patients: 89 ­patients ­with def­i­nitely diag­nosed dif­fuse infil­tra­tive ­lung dis­ease, who under­went bron­choal­ve­olar ­lavage as ­part of ­their ­initial diag­nostic ­work-up in the ­period 1991-2001. Fifty-one of ­them had ­biopsy-­proven sar­coi­dosis. Diagnostic pro­ce­dures ­were: trans­bron­chial ­lung ­biopsy (n=26), bron­chial ­biopsy (n=11), ­skin ­biopsy (n=6), sur­gical ­lung ­biopsy (n=4), super­fi­cial ­lymph ­node ­biopsy (n=3), med­i­as­tinal ­lymph ­node ­biopsy (n=1). In 38 ­patients var­ious inter­sti­tial ­lung dis­eases ­were diag­nosed, ­according to estab­lished cri­teria. Measures: we com­pared the per­centage of BAL lym­pho­cytes and CD4/CD8 ­ratio in the 2 ­groups. Sensitivity, spec­i­ficity, pos­i­tive and neg­a­tive pre­dic­tive ­value of BAL param­e­ters ­were cal­cu­lated ­with a cut-off ­value of 28% for BAL lym­pho­cytes and 3.5 for CD4/CD8 ­ratio.
Results. The per­centage of lym­pho­cytes was sim­ilar in the 2 ­groups (p=0.19); CD4/CD8 ­ratio was 5.7±4.9 in sar­coi­dosis and 2.0±3.3 in the ­other ­patients (p=0.0001). BAL CD4/CD8 ­ratio in sar­coi­dosis had sen­si­tivity 58%, spec­i­ficity 86%, pos­i­tive pre­dic­tive ­value 85%, neg­a­tive pre­dic­tive ­value 61%.
Conclusions. BAL has a low sen­si­tivity in ­patients ­with sar­coi­dosis; CD4/CD8 ­ratio ≥3.5 ­strongly sug­gests sar­coi­dosis but is not spe­cific ­enough if con­sid­ered ­alone.

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