Source: Annual Congress 2011 - Bronchoalveolar lavage and biomarkers in diffuse parenchymal lung disease

Abstract

BACKGROUND
The diagnostic strategy of the drug-induced lung disease (DILD) has not been established. It remains to be determined whether the lymphocyte transformation test (LTT) can be used for the diagnosis of DILD. Although bronchoalveolar lavage (BAL) is often performed, its usefulness in the diagnosis of DILD is still uncertain.
AIM
We aimed to evaluate the diagnostic values of BAL and LTT in patients with DILD.
METHOD
We retrospectively analyzed 47 patients who were suspected as DILD and underwent BAL and LTT between January 2004 and September 2009. The total cell number and the differential count of leukocytes in BAL fluid were determined. The levels of cytokines (eotaxin-1, -2, -3, and RANTES) in the supernatant were measured by ELISA. It was also evaluated whether these parameters were correlated with the outcome of the patients.
RESULTS
The diagnostic sensitivity and specificity of LTT were 50% and 60%, respectively. These numbers were comparable to those in previous reports. The sensitivity of increased eosinophils (>0.5%) in BAL fluid was 90%, and the specificity was 22%. The sensitivity of increased lymphocytes (>50%) was 35%, and the specificity was 78%. Furthermore, the positive likelihood ratio of LTT and increased eosinophils and lymphocytes (>10%) in BAL fluid for the prediction of the patient recovery was 0.99, 6.22, and 5.54, respectively. On the other hand, cytokine levels in the supernatant were not correlated with the diagnosis or the prognosis.
CONCLUSION
It was suggested that BAL fluid findings, especially the differential count of leukocytes, may be useful for the diagnosis and the prediction of outcome of the patients with DILD.

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Y. Kimizuka, S. Tasaka, W. Yamasawa, M. Ishii, H. Kamata, H. Fujiwara, Y. Funatsu, H. Namkoong, N. Hasegawa, M. Murata, K. Asano (Tokyo, Japan). Diagnostic value of bronchoalveolar lavage and lymphocyte transformation test in drug-induced lung disease. Eur Respir J 2011; 38: Suppl. 55, 4768

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