Chest
Clinical InvestigationsPredictive Value of Bronchoalveolar Lavage in Pulmonary Sarcoidosis
Section snippets
Subjects
Fifty-nine consecutive patients with untreated pulmonary sarcoidosis underwent BAL as a diagnostic procedure between December 1981 and February 1987. Of these patients, 23 were not available for follow-up and five were excluded from this study because corticosteroid therapy was started immediately after the BAL. Thirty-one patients (20 women, 11 men) were followed up for a period of 22 to 81 months (median, 43 months).
The diagnosis of pulmonary sarcoidosis satisfied the following three
Initial Disease Activity Indices and Radiologic Stage
In Table 1, the patient population under study is presented. The results of the BAL cellular composition and the SACE level are given according to the radiologic stage at the start of follow-up. There was a significantly lower lymphocyte count in stage III patients vs stage I and II patients. The T4-T8 ratio was highest in stage I disease and correlated negatively with the radiologic stage (Rs = –0.45; p<0.02). Moreover, the proportion of T8 cells (expressed as percentage of lymphocytes)
DISCUSSION
In this article, we report that in patients with untreated sarcoidosis, the total cell count and the lymphocyte cell count in the BAL fluid are not predictive of the evolution of the disease. A high T4 cell count or a high T4-T8 ratio in the BAL seem to be indicators of a good prognosis. Patients who improved radiologically had a significantly higher T4 cell count (as percentage of lymphocytes) and a significantly higher T4-T8 ratio in the initial BAL; also, the evolution of the Dco correlated
ACKNOWLEDGMENTS
We want to thank Mariette Roozenkrans and Lisette Meurs for technical help in the analysis of BAL samples, and Heidi Verheyden for typing the manuscript.
REFERENCES (35)
- et al.
Clinical applications of bronchoalveolar lavage: an interim view
Br J Dis Chest
(1986) - et al.
The impact of bronchoalveolar lavage cell analysis on clinicians’ diagnostic reasoning about interstitial lung disease
Chest
(1987) - et al.
Value of serial measurement of serum angiotensin-converting enzyme in the management of sarcoidosis
Am J Med
(1981) Sarcoidosis: clinical features and management
Med Clin North Am
(1967)- et al.
CD8 + cell-dominant alveolitis in pulmonary sarcoidosis
Chest
(1989) - et al.
Analysis of proteins and respiratory cells obtained from human lungs by bronchoalveolar lavage
J Lab Clin Med
(1974) Bronchoalveolar lavage
Am Rev Respir Dis
(1987)Bronchoalveolar lavage in the investigation of disorders of the lower respiratory tract
Eur J Respir Dis
(1986)- et al.
Current concepts of the pathogenesis of sarcoidosis
Am Rev Respir Dis
(1987) - et al.
Pulmonary sarcoidosis: a disease characterized and perpetuated by activated lung T lymphocytes
Ann Intern Med
(1981)
Recent advances in sarcoidosis
Eur J Respir Dis
Ia-like antigens on T cells and their subpopulations in pulmonary sarcoidosis and in hypersensitivity pneumonitis: analysis of bronchoalveolar and blood lymphocytes
Am Rev Respir Dis
The alveolitis of pulmonary sarcoidosis: evaluation of natural history and alveolitis-dependent changes in lung function
Am Rev Respir Dis
Predictive value of bronchoalveolar T cell subsets for the course of pulmonary sarcoidosis
Ann NY Acad Sci
Bronchoalveolar lavage cell analysis in sarcoidosis: a comparison of lymphocyte counts and clinical course
Ann NY Acad Sci
Pulmonary sarcoidosis: alterations in bronchoalveolar lymphocytes and T cell subsets
Thorax
Prognostic value of bronchoalveolar lavage in sarcoidosis: the critical influence of disease presentation
Thorax
Cited by (63)
Biomarkers in Sarcoidosis
2018, Sarcoidosis: A Clinician's GuideComparative evaluation of serum markers in pulmonary sarcoidosis
2010, ChestCitation Excerpt :The serum KL-6 level at diagnosis might have a useful predictive value for increased parenchymal infiltration in pulmonary sarcoidosis. Previous studies showed that BAL lymphocytes and serum sIL-2R were suitable parameters for predicting disease progression, although contrary results have also been reported.4,20,23–25 Furthermore, it was reported that serum ACE and lysozyme did not correlate with prognosis.20,21
The clinical significance of interleukin 18 assessment in sarcoidosis patients
2007, Respiratory MedicineCitation Excerpt :Some studies have shown that basing on these BALF parameters it has been possible to predict the deterioration of the sarcoidosis course. Numerous studies have found that the disease course in patients with an initial high percentage of BALF lymphocytes and a high value of the CD4/CD8 ratio has improved.23,24 However, other investigations have shown that BALF lymphocyte count is not significant in the course of sarcoidosis.25
Serum soluble interleukin-2 receptor measurement in patients with sarcoidosis: A clinical evaluation
2003, ChestCitation Excerpt :This study rather suggests the opposite as we found a weak association between higher initial sIL-2R levels and normalization of chest radiograph at long-term follow-up. In our opinion, this finding, although not significant, is consistent with the afore-mentioned correlation (ie, between sIL-2R level and the number of CD4+ T lymphocytes in BAL), as spontaneous remission of sarcoidosis is more likely to occur in patients presenting with a high degree of alveolitis and low chest radiographic stage.1322 Apparently, from the above, elevated serum sIL-2R levels should be carefully interpreted in the presence of clinical, radiographic, and BAL findings.
Sarcoidosis-associated pulmonary fibrosis: joining the dots
2023, European Respiratory Review
Manuscript received November 27; revision accepted February 16.
Reprint requests: Dr. Ceuppens, Lab Klinische Immunologie·, Universitair Ziekenhuis, 3000 Leuven, Belgium