The diagnostic value of bronchoalveolar lavage and transbronchial lung biopsy in cryptogenic organizing pneumonia
TLDR
In this article, the diagnostic value of bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) in cryptogenic organizing pneumonia (COP) was determined.Abstract:
In order to determine the diagnostic value of bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) in cryptogenic organizing pneumonia (COP) a prospective study was carried out. Thirty seven consecutive patients (20 males and 17 females) with clinicoradiological features of COP were enrolled in the study. The statistical analyses were completed in 35 cases. Twenty eight patients were diagnosed to have COP, all of them with a confirmatory biopsy. In seven cases, a different diagnosis was made. BAL cytological and phenotypical criteria considered for the diagnosis of COP were: a lymphocytosis of more than 25% (with a CD4/CD8 ratio less than 0.9); combined with at least two of the following data (foamy macrophages of > 20%, and/or neutrophils of > 5%, and/or eosinophils of > 2% and < 25%). TBLB specimens were classified as positive for COP if they showed: buds of granulation tissue within the centrilobular air spaces; infiltration of alveolar walls with chronic inflammatory cells; and preservation of alveolar architecture. BAL was performed in 34 patients; 17 cases were consistent with the final diagnosis of COP (sensitivity 63%), and four cases were correctly classified as negative (specificity 57%). BAL had a positive predictive value (PPV) of 85% and a negative predictive value (NPV) of 29%. TBLB was performed in 32 patients; it correctly identified COP in 16 cases (sensitivity 64%), and six cases were correctly classified as negative (specificity 86%). TBLB had a PPV of 94% and a NPV of 40%. The accuracy of the examinations, that is the probability of correctly diagnosing both diseased and nondiseased patients by BAL or TBLB, was 62 and 69%, respectively. Our findings suggest that the combination of cytological bronchoalveolar lavage and histological transbronchial lung biopsy data obtained during a fibreoptic procedure appears to be an effective method for the initial investigation in cryptogenic organizing patients pneumonia presenting with patchy radiographic shadows.read more
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References
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Journal ArticleDOI
Pathologic Aspects of Bronchiolitis Obliterans Organizing Pneumonia
TL;DR: The eponym BOOR derives from histologic presence of bronchiolitis obliterans and organizing pneumonia, which is a relatively recent term for a cinicopathologic entity that has been recognized for some time.
Journal Article
Bronchiolitis obliterans organizing pneumonia (BOOP): the cytological and immunocytological profile of bronchoalveolar lavage
TL;DR: BAL may be of value to distinguish between BOOP and other interstitial lung disease, and the increase in lymphocytes discriminated best between BOop and IPF.
Journal ArticleDOI
Idiopathic bronchiolitis obliterans organizing pneumonia with peripheral infiltrates on chest roentgenogram.
TL;DR: It is speculated that a lung biopsy may be adequate to establish a working clinical diagnosis of BOOP and that idiopathic BOOP may represent the evolution of untreated CEP.
Journal ArticleDOI
Organizing Pneumonia-like Process: An Unusual Observation in Steroid Responsive Cases with Features of Chronic Interstitial Pneumonia
TL;DR: Two patients under long-term surveillance showed the similar clinical features of low-grade fever, scanty productive cough, progressive dyspnea, and roentgenologic findings of lung infiltrates as mentioned in this paper.
Journal ArticleDOI
The histological diagnosis of clinically documented cases of cryptogenic organizing pneumonia: diagnostic features in transbronchial biopsies.
Roberto Dina,M.N. Sheppard +1 more
TL;DR: Transbronchial biopsy can yield diagnostic material in the majority of patients with cryptogenic organizing pneumonia while open lung biopsy, which is considered the gold standard for interstitial lung disease, may yield negative results because of sampling error and the rapid evolution and changing pattern of the disease.