Abstract
BackgroundThe utility of bronchoscopy for patients with suspected immune checkpoint inhibitor (ICI)-related pneumonitis is currently debatable. The purpose of this study was to examine the findings of bronchoalveolar lavage (BAL) analysis and transbronchial lung biopsy (TBLB) in non-small cell lung cancer (NSCLC) patients with ICI-related pneumonitis, and to elucidate the clinical significance of bronchoscopy for this health condition.Patients and methodsConsecutive NSCLC patients treated with ICIs, diagnosed with ICI-related pneumonitis after undergoing bronchoscopy between October 2015 and March 2019 were retrospectively screened. Findings of BAL fluid analysis and/or TBLB specimen histology were reviewed.ResultsTwelve patients underwent bronchoscopy for the diagnosis of ICI-related pneumonitis, ten of whom underwent BAL. An increase in the proportion of lymphocytes higher than 20% was observed in all ten patients. An increase in the proportion of neutrophils (> 10%) and eosinophils (> 10%) was observed in two and one patient, respectively. TBLB specimens were analyzed for eight patients. Major histologic findings included alveolitis in seven (87.5%) and organizing pneumonia (OP) in five (62.5%) patients. Other findings included acute lung injury and fibrosis. All twelve patients demonstrated favorable outcomes.ConclusionA major characteristic of BAL analysis in ICI-related pneumonitis with NSCLC was an increased proportion of lymphocytes. The histologic features of lung tissue included alveolitis and/or OP. Acute lung injury and fibrosis were observed. Although the necessity of bronchoscopy should be determined on a case-by-case basis, it is necessary to assess these parameters when proper differential diagnosis is needed.
Highlights
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of many types of cancer
In this study, we examined the findings of bronchoalveolar lavage (BAL) and/or transbronchial lung biopsy (TBLB) in twelve consecutive non-small cell lung cancer (NSCLC) patients with ICIrelated pneumonitis
The present study suggests that alveolitis and organizing pneumonia (OP) are major pathologic findings of lung specimens for patients with ICI-related pneumonitis, which do not necessarily correspond to radiologic patterns
Summary
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of many types of cancer. In patients with non-small cell lung cancer (NSCLC) who received ICI monotherapy, the incidence of ICIrelated pneumonitis for all grades was reported to range from 1 to 12% [7]. Recent meta-analyses reported that the overall incidence of ICI-related pneumonitis is 4.5% [8]. The utility of bronchoscopy for patients with suspected immune checkpoint inhibitor (ICI)-related pneumonitis is currently debatable. The purpose of this study was to examine the findings of bronchoalveolar lavage (BAL) analysis and transbronchial lung biopsy (TBLB) in non-small cell lung cancer (NSCLC) patients with ICI-related pneumonitis, and to elucidate the clinical significance of bronchoscopy for this health condition
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