Chamberlain D W, Braude A C, Rebuck A S
Department of Pathology, Toronto General Hospital, Ontario, Canada.
Acta Cytol. 1987 Sep-Oct;31(5):599-605.
In a multicenter, city-wide study of the use of bronchoalveolar lavage for the evaluation of diffuse interstitial lung diseases, the occurrence of specimens unsuitable for analysis was evaluated. Using a standardized bronchoscopy technique, 26 physicians obtained 1,588 lavage specimens from 787 patients over a 52-month period. After transport to and processing in one laboratory using standardized procedures, all specimens were interpreted by one pathologist. Specimens were considered unsatisfactory if they contained: (1) a paucity of alveolar macrophages (i.e., less than ten alveolar macrophages/high-power field), (2) excessive numbers of airway-derived cells (i.e., more than the alveolar macrophages present), (3) a mucopurulent exudate, (4) cells altered by degeneration or (5) laboratory artifacts. Using these criteria, 30.4% of the specimens were considered unsuitable for analysis. There were no significant differences in the frequency of unsatisfactory specimens among participating physicians and institutions or between smoking and nonsmoking patients. Appraisal of alveolar inflammatory and immune effector cells in bronchoalveolar lavage specimens from patients with interstitial lung disease should include an assessment for contamination from airways proximal to the terminal bronchioles before conclusions are drawn about the activity of alveolar inflammation.
在一项关于使用支气管肺泡灌洗术评估弥漫性间质性肺疾病的全市多中心研究中，对不适合分析的标本发生率进行了评估。采用标准化支气管镜检查技术，26名医生在52个月的时间里从787例患者中获取了1588份灌洗标本。在将所有标本运至一个实验室并采用标准化程序进行处理后，由一名病理学家进行解读。如果标本存在以下情况，则被认为不合格：（1）肺泡巨噬细胞数量稀少（即每高倍视野少于10个肺泡巨噬细胞），（2）气道来源的细胞数量过多（即超过肺泡巨噬细胞的数量），（3）黏液脓性渗出物，（4）因变性而改变的细胞，或（5）实验室假象。根据这些标准，30.4%的标本被认为不适合分析。参与研究的医生和机构之间，以及吸烟患者与非吸烟患者之间，不合格标本的发生率没有显著差异。在对间质性肺疾病患者的支气管肺泡灌洗标本中的肺泡炎症和免疫效应细胞进行评估时，在就肺泡炎症活动得出结论之前，应评估来自终末细支气管近端气道的污染情况。
