Tunis Med. 2021;99(8):869-876.
Interstitial lung disease represents a challenge and consists in more than 200 entities. Their diagnoses are assessed through a multidisciplinary approach including pulmonologists, radiologists, pathologists and biologists. BAL analysis is useful mainly when clinical and radiological findings aren't suggestive of an etiology. Even if, the indication of BAL is consensual, its real place as a diagnostic mean remains non consensual.
To describe the BAL findings and to analyse the perceptions of the pulmonologists, anaesthesiologists and pathologists implicated in the interpretation of the BAL data, that are related to the presentation and the validity of the results.
the authors performed a descriptive study about BAL results during an 8-year-period (2010-2018) and a qualitative study assessing the pulmonologists, anaesthesiologists and pathologists' opinions concerning the different results performed in the same institution. Two questionnaires were conceived with participation of different experts and satisfaction scores were calculated.
2508 BAL were recorded including 1320 women (53%) and 1188 men (47%) with a sex-ratio (H/F) of 0,9. The mean age of the patients was 51 years. The mean response delay was 3.25 days. An accurate diagnosis was retained in 24.3%. It consisted in infection evoked in 13.89% cases. Eosinophilic pneumonia was evoked in 0.35% cases. 15.01% cases presented erythrophagocytosis with a golde score>100 favouring active alveolar haemorrhage with occult alveolar haemorrhage. Lipoproteinosis was diagnosed in 2 cases. Adenocarcinoma was retained in 1.04% cases and lymphoma in 0.16% cases. Langerhans cell histiocytosis was confirmed in 1.51% cases. In the other cases, cellular profile was not specific evoking tuberculosis or sarcoidosis in 316 cases with a CD4/CD8 ratio superior to 1,6 and the diagnoses of tuberculosis or hypersensitivity pneumonia in 202 cases with a CD4/CD8 ratio inferior to 1,2. Concerning the questionnaire-based study, 50 pulmonologists and anaesthesiologists attributed a mean score of 7.96/10 (DS=0.55) concerning the presentation of the results and 9.28/15 (DS=0.77) concerning the quality and validity of the results. On the other hand, the mean satisfaction score rated by pathologists reached 24/40.
BAL results could be helpful for the management of interstitial lung disease depending on the experience of pathologists and a good communication between pulmonologists, anaesthesiologists and pathologists.
间质性肺疾病是一个挑战，包括 200 多种疾病。其诊断通过包括肺科医生、放射科医生、病理学家和生物学家在内的多学科方法进行评估。BAL 分析主要在临床和影像学检查结果不提示病因时有用。尽管 BAL 的适应证已经达成共识，但它作为一种诊断手段的实际地位仍然存在争议。
描述 BAL 的结果，并分析参与 BAL 数据分析解释的肺科医生、麻醉师和病理学家的看法，这些看法与结果的呈现和有效性有关。
作者对 8 年期间（2010-2018 年）的 BAL 结果进行了描述性研究，并对同一机构进行的不同结果进行了评估，以评估肺科医生、麻醉师和病理学家的意见的定性研究。设计了两个调查问卷，邀请了不同的专家参与，并计算了满意度评分。
共记录了 2508 例 BAL，包括 1320 名女性（53%）和 1188 名男性（47%），性别比（H/F）为 0.9。患者的平均年龄为 51 岁。平均反应延迟为 3.25 天。保留了 24.3%的准确诊断。它包括 13.89%的感染诱发病例。嗜酸性肺炎占 0.35%。15.01%的病例出现血红细胞吞噬现象，戈尔德评分>100，提示肺泡隐性出血伴肺泡显性出血。诊断为 2 例脂蛋白病。腺癌占 1.04%，淋巴瘤占 0.16%。朗格汉斯细胞组织细胞增生症得到证实，占 1.51%。在其他病例中，细胞特征不具有特异性，提示 316 例结核病或结节病的 CD4/CD8 比值大于 1.6，202 例结核病或超敏性肺炎的 CD4/CD8 比值小于 1.2。关于基于问卷的研究，50 名肺科医生和麻醉师对结果的呈现给予平均 7.96/10（DS=0.55）的评分，对结果的质量和有效性给予平均 9.28/15（DS=0.77）的评分。另一方面，病理学家的平均满意度评分达到 24/40。
BAL 结果可有助于管理间质性肺疾病，这取决于病理学家的经验以及肺科医生、麻醉师和病理学家之间的良好沟通。
Zotero 插件