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From the authors

Laboratory of Cytology, Hospital Grosshansdorf, Center of Pneumology and Thoracic Surgery, Grosshandorf, Germany

We would like to thank S. Greco and coworkers for their comments on our paper about the predictive value of bronchoalveolar lavage (BAL) cell differentials in the diagnosis of interstitial lung disease (ILD) 1. In their study, which they discuss in their letter to the Editors, they tested the feasibility of our data for the differential diagnosis of pulmonary tuberculosis (TB) and sarcoidosis. In contrast to our study, they retrospectively analysed 88 patients with biopsy-proven sarcoidosis and 76 patients with culture-positive pulmonary TB.

First of all, we agree with the major points of their study. The high grade of lymphocytosis (>50%) is the best predictor for sarcoidosis, and the presence of elevated neutrophils rendered the diagnosis of sarcoidosis very unlikely. In our experience and clinical practise, however, the proportion of TB with a comparable ILD pattern seems to be extremely low. In our own hospital (Hospital Grosshansdorf, Center of Pneumology and Thoracic Surgery, Grosshandorf, Germany), >100 patients per year are treated for TB. Within the study interval of 7 yrs (700 TB patients), only seven of these patients showed a clinical and/or radiological pattern of ILD 1.

Although many clinicians use BAL fluid to confirm the diagnosis of TB microbiologically, it does not seem to be the only diagnostic tool that can be used to confirm TB. In addition, other diseases with an ILD pattern (nonsarcoid ILD) are much more frequent than TB with an ILD pattern. In our study 1, nonsarcoid ILD is not equal to TB with an ILD pattern. Therefore, the lower predictive value seen in the study by S. Greco and coworkers is not unexpected.

Our analysis was carried out in a manner similar to that adopted by most clinicians in the diagnostic process, with a special emphasis on interstitial lung disease. The use of cut-off values in the interpretation of bronchoalveolar lavage cellular results seems to be more practical compared with the use of a discriminant score.

REFERENCES

1. Welker L, Jorres RA, Costabel U, Magnussen H. Predictive value of BAL cell differentials in the diagnosis of interstitial lung disease. Eur Respir J 2004;24:1000–1006.[Abstract/Free Full Text]

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