Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Hypersensitivity Pneumonitis

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Abstract

Introduction: Making the diagnosis of HP is challenging due to a lack of consensus criteria and variability of both pathologic and radiographic findings. The purpose of this retrospective study was to determine the diagnostic utility of the combination of BAL lymphocyte count and TBBX in patients with HP. Methods: We conducted a retrospective cohort study of all patients with a MDD diagnosis of HP at a single center. Results: 155 patients were included in the study. 49% of patients who underwent BAL had a lymphocyte count > 20, 42% had a lymphocyte count > 30, and 34% had lymphocyte count > 40%. The median BAL lymphocyte count was higher in inflammatory HP compared to fibrotic HP. The addition of TBBX to BAL significantly increased the diagnostic yield regardless of the BAL lymphocyte cutoff used. The yield of bronchoscopy with TBBX and BAL when a lymphocyte count > 40% was used as a cutoff was 52%. Conclusions: Our study suggests that the combination of TBBX with BAL significantly increases the likelihood that the procedure will provide adequate additional information to allow a confident MDD diagnosis of HP and may reduce the need for SLB in the diagnostic workup of HP.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalLung
DOIs
StateAccepted/In press - Jun 29 2018

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Extrinsic Allergic Alveolitis
Dimercaprol
Bronchoalveolar Lavage
Lymphocyte Count
Biopsy
Retrospective Studies
Bronchoscopy
Cohort Studies
Lymphocytes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

@article{73583a112dc5415a81e0d34ff3564760,
title = "Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Hypersensitivity Pneumonitis",
abstract = "Introduction: Making the diagnosis of HP is challenging due to a lack of consensus criteria and variability of both pathologic and radiographic findings. The purpose of this retrospective study was to determine the diagnostic utility of the combination of BAL lymphocyte count and TBBX in patients with HP. Methods: We conducted a retrospective cohort study of all patients with a MDD diagnosis of HP at a single center. Results: 155 patients were included in the study. 49{\%} of patients who underwent BAL had a lymphocyte count > 20, 42{\%} had a lymphocyte count > 30, and 34{\%} had lymphocyte count > 40{\%}. The median BAL lymphocyte count was higher in inflammatory HP compared to fibrotic HP. The addition of TBBX to BAL significantly increased the diagnostic yield regardless of the BAL lymphocyte cutoff used. The yield of bronchoscopy with TBBX and BAL when a lymphocyte count > 40{\%} was used as a cutoff was 52{\%}. Conclusions: Our study suggests that the combination of TBBX with BAL significantly increases the likelihood that the procedure will provide adequate additional information to allow a confident MDD diagnosis of HP and may reduce the need for SLB in the diagnostic workup of HP.",
author = "Adams, {Traci N.} and Newton, {Chad A.} and Kiran Batra and Muhanned Abu-Hijleh and Tyonn Barbera and Jose Torrealba and Glazer, {Craig S.}",
year = "2018",
month = "6",
day = "29",
doi = "10.1007/s00408-018-0139-1",
language = "English (US)",
pages = "1--6",
journal = "Lung",
issn = "0341-2040",
publisher = "Springer New York",

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TY - JOUR

T1 - Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Hypersensitivity Pneumonitis

AU - Adams, Traci N.

AU - Newton, Chad A.

AU - Batra, Kiran

AU - Abu-Hijleh, Muhanned

AU - Barbera, Tyonn

AU - Torrealba, Jose

AU - Glazer, Craig S.

PY - 2018/6/29

Y1 - 2018/6/29

N2 - Introduction: Making the diagnosis of HP is challenging due to a lack of consensus criteria and variability of both pathologic and radiographic findings. The purpose of this retrospective study was to determine the diagnostic utility of the combination of BAL lymphocyte count and TBBX in patients with HP. Methods: We conducted a retrospective cohort study of all patients with a MDD diagnosis of HP at a single center. Results: 155 patients were included in the study. 49% of patients who underwent BAL had a lymphocyte count > 20, 42% had a lymphocyte count > 30, and 34% had lymphocyte count > 40%. The median BAL lymphocyte count was higher in inflammatory HP compared to fibrotic HP. The addition of TBBX to BAL significantly increased the diagnostic yield regardless of the BAL lymphocyte cutoff used. The yield of bronchoscopy with TBBX and BAL when a lymphocyte count > 40% was used as a cutoff was 52%. Conclusions: Our study suggests that the combination of TBBX with BAL significantly increases the likelihood that the procedure will provide adequate additional information to allow a confident MDD diagnosis of HP and may reduce the need for SLB in the diagnostic workup of HP.

AB - Introduction: Making the diagnosis of HP is challenging due to a lack of consensus criteria and variability of both pathologic and radiographic findings. The purpose of this retrospective study was to determine the diagnostic utility of the combination of BAL lymphocyte count and TBBX in patients with HP. Methods: We conducted a retrospective cohort study of all patients with a MDD diagnosis of HP at a single center. Results: 155 patients were included in the study. 49% of patients who underwent BAL had a lymphocyte count > 20, 42% had a lymphocyte count > 30, and 34% had lymphocyte count > 40%. The median BAL lymphocyte count was higher in inflammatory HP compared to fibrotic HP. The addition of TBBX to BAL significantly increased the diagnostic yield regardless of the BAL lymphocyte cutoff used. The yield of bronchoscopy with TBBX and BAL when a lymphocyte count > 40% was used as a cutoff was 52%. Conclusions: Our study suggests that the combination of TBBX with BAL significantly increases the likelihood that the procedure will provide adequate additional information to allow a confident MDD diagnosis of HP and may reduce the need for SLB in the diagnostic workup of HP.

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