Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, TX 77030-4009, USA.
Cancer. 2011 Aug 1;117(15):3424-33. doi: 10.1002/cncr.25905. Epub 2011 Jan 18.
Flexible bronchoscopy with bronchoalveolar lavage (BAL) is performed widely for the diagnosis of pulmonary infections in patients with cancer, but there is no consensus regarding the technical parameters of the lavage procedure in this setting.
The authors evaluated the mechanics (instilled and recovered volumes), diagnostic yield, and safety of a standardized BAL protocol in 284 patients with cancer who underwent bronchoscopy for the evaluation of new radiologic infiltrates.
Physician adherence to the BAL protocol was > 90%. The most common protocol deviations were reductions in the saline volume instilled because of actual or anticipated oxyhemoglobin desaturation during the procedure. The mean volume instilled was 121.5 ± 13.9 mL, the mean volume recovered was 68.7 ± 18.1 mL, and the mean ratio of volume instilled to that recovered was 56.7% ± 14.5%. The overall diagnostic yield of BAL was 33.8% and was higher in the nonhematologic malignancy group (42.3% vs 29.4%; P = .021). The diagnostic yield in neutropenic patients was significantly higher than in non-neutropenic patients (41.5% vs 24.6%; P = .019). No major complications were encountered.
In summary, the diagnostic performance of a standardized BAL protocol was comparable to that of nonprotocolized BAL reported in the literature with few complications. Adherence to a standardized BAL protocol may improve clinical and laboratory comparisons between studies, potentially facilitating research into the diagnosis and management of pneumonia in patients with cancer.
经支气管镜肺泡灌洗（BAL）广泛应用于癌症患者肺部感染的诊断，但在这种情况下，灌洗程序的技术参数尚未达成共识。
作者评估了 284 例因新发影像学浸润行支气管镜检查以评估病情的癌症患者的支气管镜肺泡灌洗（BAL）标准化方案的操作力学（灌洗和回收量）、诊断效果和安全性。
医师对 BAL 方案的依从性>90%。最常见的方案偏差是由于在操作过程中实际或预期的氧合血红蛋白饱和度降低而减少灌洗的生理盐水量。平均灌洗量为 121.5±13.9ml，平均回收量为 68.7±18.1ml，平均灌洗与回收比为 56.7%±14.5%。BAL 的总体诊断率为 33.8%，非血液恶性肿瘤组的诊断率更高（42.3%比 29.4%；P=0.021）。中性粒细胞减少症患者的诊断率明显高于非中性粒细胞减少症患者（41.5%比 24.6%；P=0.019）。未发生主要并发症。
综上所述，标准化 BAL 方案的诊断性能与文献报道的非标准化 BAL 相当，且并发症较少。遵循标准化 BAL 方案可能会改善研究之间的临床和实验室比较，从而有助于癌症患者肺炎的诊断和治疗研究。
