The role of fiberoptic bronchoscopy in the evaluation of immunocompromised hosts with diffuse pulmonary infiltrates.

To define the utility of fiberoptic bronchoscopy in the evaluation of immunocompromised patients with diffuse pulmonary infiltrates, we reviewed our experience between January 1980, and January 1983, with 50 such patients with a wide variety of underlying diseases. Of these, 35 patients underwent bronchoscopy, including brushings, alveolar lavage, and transbronchial biopsy, and 15 underwent open lung biopsy; 8 patients underwent both procedures. All patients with a nondiagnostic bronchoscopy either recovered without specific antibiotic therapy or underwent an open procedure. A diagnosis was made in 29 patients (58%). An infectious process was found in 20 patients (40%). A diagnosis was made bronchoscopically in 19 patients including 18 infections. Transbronchial biopsy was rarely diagnostic of infection when brushings were negative. For all diagnoses, bronchoscopy had a sensitivity of 76.9%. For all pulmonary infections, bronchoscopy had a sensitivity of 90%. Given a negative bronchoscopy, the probability that an infection was not present (i.e., predictive value negative) was 94.4%. Unfortunately, making a specific diagnosis did not appear to greatly improve survival. We conclude that in this setting: (1) fiberoptic bronchoscopy is an extremely sensitive procedure for diagnosing pulmonary infections, (2) bronchial brushings are as useful as transbronchial biopsies for diagnosing nonfungal infections, (3) these procedures are less useful for diagnosing noninfectious conditions, and (4) in the face of a negative bronchoscopic procedure, there is a very low probability that an infectious process will be found with an open biopsy.