DeFine L A, Saleba K P, Gibson B B, Wesseler T A, Baughman R
Acta Cytol. 1987 May-Jun;31(3):235-42.
The role of bronchoalveolar lavage cytology in the diagnostic evaluation of immunosuppressed patients with suspected opportunistic pulmonary infections was evaluated by comparing two groups of patients who underwent fiberoptic bronchoscopy. Bronchoalveolar lavage specimens were compared with other available diagnostic techniques, including bronchial washings, bronchial brushings, transbronchial lung biopsies and open lung biopsy. Prior to the initiation of a protocol for bronchoalveolar lavage, a specific etiology for the pulmonary infiltrate using the above combined modalities was identified in 23 of 47 cases, for an overall diagnostic rate of 49%. The combined bronchial washings and brushings (cytologic procedures) identified a specific etiology in 9 of 47 (19%) of the cases. There were ten cases in which a cytologically identifiable organism (Pneumocystis, virus or fungus) was not present in the bronchial washings and brushings and one missed case of malignancy, for a false-negative rate of 23%. With the addition of the lavage technique and better sampling of the distal airways, a specific etiology for the pulmonary infiltrate was identified in 32 of 48 (67%) of the cases. This is comparable to the values of 40% to 65% cited in the literature for diagnosis of infectious disease by open lung biopsy. The lavage cytologic procedure identified a specific etiology in 22 of 48 (46%) of the cases, and the false-negative rate was reduced to 6%. With the excellent sampling of the bronchoalveolar lavage and the improved cytology results, the need for transbronchial or open lung biopsy has been eliminated in immunosuppressed patients with suspected opportunistic pulmonary infections. This allows these patients to be studied on an outpatient basis.
通过比较两组接受纤维支气管镜检查的患者，评估了支气管肺泡灌洗细胞学在免疫抑制且疑似机会性肺部感染患者诊断评估中的作用。将支气管肺泡灌洗标本与其他可用的诊断技术进行比较，包括支气管冲洗、支气管刷检、经支气管肺活检和开胸肺活检。在启动支气管肺泡灌洗方案之前，使用上述联合方法在47例中的23例中确定了肺部浸润的具体病因，总体诊断率为49%。联合支气管冲洗和刷检（细胞学检查）在47例中的9例（19%）中确定了具体病因。有10例支气管冲洗和刷检中未发现细胞学可识别的病原体（肺孢子菌、病毒或真菌），还有1例恶性肿瘤漏诊，假阴性率为23%。加上灌洗技术和对远端气道更好的采样，在48例中的32例（67%）中确定了肺部浸润的具体病因。这与文献中报道的开胸肺活检诊断传染病的40%至65%的值相当。灌洗细胞学检查在48例中的22例（46%）中确定了具体病因，假阴性率降至6%。由于支气管肺泡灌洗的出色采样和细胞学结果的改善，疑似机会性肺部感染的免疫抑制患者不再需要进行经支气管或开胸肺活检。这使得这些患者可以在门诊接受检查。
