BAL as a diagnostic tool in sarcoidosis and hypersensitivity pneumonitis

Background: BAL in patients with sarcoidosis and hypersensitivity pneumonitis is safe, minimally invasive, but it does not reveal specific information. Does it give us any support in diagnostic procedures in these two diseases?

Patients and methods: 361 patients with sarcoidosis and 77 patients with HP have been diagnosed in our clinic in years 1996–2002. BAL was done in acordance with ERS technical recommendations and guidelines. In all cases sarcoidosis was histologically confirmed. In HP histological findings were typical as well.

Results: In 361 sarcoidosis patients CD4 lymphocytic alveolitis was found (mean value 29,7%ly). CD4/CD8 >5 (mean value 6,12) had 54% sensitivity and 92% specificity in sarcoidosis.

In 77 patients with HP striking lymphocytosis (mean value 28,6%) in BAL with CD8 predominance (CD4/CD8 mean value 1,09) and BAL neutrophilia in acute episodes were found.

In sarcoidosis and HP were differences of citologic findings in BAL from two different lobes not statistically significant.

Conclusions: BAL is non-specific but supportive diagnostic procedure in sarcoidosis and HP. In these two diseases in accordance with adequate clinical signs and radiological findings BAL can contribute to the diagnose.