Poletti V, Cazzato S, Minicuci N, Zompatori M, Burzi M, Schiattone M L
Divisione di Pneumologia, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Eur Respir J. 1996 Dec;9(12):2513-6. doi: 10.1183/09031936.96.09122513.
In order to determine the diagnostic value of bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) in cryptogenic organizing pneumonia (COP) a prospective study was carried out. Thirty seven consecutive patients (20 males and 17 females) with clinicoradiological features of COP were enrolled in the study. The statistical analyses were completed in 35 cases. Twenty eight patients were diagnosed to have COP, all of them with a confirmatory biopsy. In seven cases, a different diagnosis was made. BAL cytological and phenotypical criteria considered for the diagnosis of COP were: a lymphocytosis of more than 25% (with a CD4/CD8 ratio less than 0.9); combined with at least two of the following data (foamy macrophages of > 20%, and/or neutrophils of > 5%, and/or eosinophils of > 2% and < 25%). TBLB specimens were classified as positive for COP if they showed: buds of granulation tissue within the centrilobular air spaces; infiltration of alveolar walls with chronic inflammatory cells; and preservation of alveolar architecture. BAL was performed in 34 patients; 17 cases were consistent with the final diagnosis of COP (sensitivity 63%), and four cases were correctly classified as negative (specificity 57%). BAL had a positive predictive value (PPV) of 85% and a negative predictive value (NPV) of 29%. TBLB was performed in 32 patients; it correctly identified COP in 16 cases (sensitivity 64%), and six cases were correctly classified as negative (specificity 86%). TBLB had a PPV of 94% and a NPV of 40%. The accuracy of the examinations, that is the probability of correctly diagnosing both diseased and nondiseased patients by BAL or TBLB, was 62 and 69%, respectively. Our findings suggest that the combination of cytological bronchoalveolar lavage and histological transbronchial lung biopsy data obtained during a fibreoptic procedure appears to be an effective method for the initial investigation in cryptogenic organizing patients pneumonia presenting with patchy radiographic shadows.
为了确定支气管肺泡灌洗（BAL）和经支气管肺活检（TBLB）在隐源性机化性肺炎（COP）中的诊断价值，开展了一项前瞻性研究。连续纳入37例具有COP临床和放射学特征的患者（20例男性和17例女性）。35例完成了统计分析。28例患者被诊断为COP，均经活检证实。7例诊断为其他疾病。用于诊断COP的BAL细胞学和表型标准为：淋巴细胞增多超过25%（CD4/CD8比值小于0.9）；并结合以下至少两项数据（泡沫巨噬细胞>20%，和/或中性粒细胞>5%，和/或嗜酸性粒细胞>2%且<25%）。如果TBLB标本显示：小叶中心气腔内有肉芽组织芽；肺泡壁有慢性炎性细胞浸润；且肺泡结构保存，则分类为COP阳性。34例患者进行了BAL；17例与COP最终诊断一致（敏感性63%），4例被正确分类为阴性（特异性57%）。BAL的阳性预测值（PPV）为85%，阴性预测值（NPV）为29%。32例患者进行了TBLB；16例正确诊断为COP（敏感性64%），6例被正确分类为阴性（特异性86%）。TBLB的PPV为94%，NPV为40%。BAL和TBLB检查的准确性，即正确诊断患病和未患病患者的概率，分别为62%和69%。我们的研究结果表明，在纤维支气管镜检查过程中获得的细胞学支气管肺泡灌洗和组织学经支气管肺活检数据相结合，似乎是对表现为斑片状放射影的隐源性机化性肺炎患者进行初步检查的有效方法。
