Bronchoalveolar Cytology Research Articles

Integrated approach to bronchoalveolar lavage cytology to distinguish interstitial lung diseases

BackgroundBroncho-alveolar lavage (BAL) is a safe diagnostic procedure, useful for differentiating fibrotic lung disorders and for excluding malignancy and infection. A recent multicenter study demonstrated a new, relatively sensitive, and specific index called Bronchoalveolar Cytology Threshold (BCT), useful for distinguishing healthy individuals from patients with lung diseases. ObjectivesIn our study, BCT was applied for the first time to the analysis of interstitial lung diseases (ILDs), investigating its potential for differential diagnosis. Combinations of BAL cells that improve diagnostic accuracy for ILDs were studied and are proposed. MethodsA retrospective analysis of BAL samples was performed. We considered more than 1000 BAL samples from patients investigated for ILD, performed at Siena University Hospital.The samples enrolled for the study included 468 patients: 413 with and 55 without ILD. BAL was performed for diagnostic purposes in line with international guidelines. BCT were calculated according to available literature. ResultsAmong ILDs, patients with fibrotic hypersensitivity pneumonitis, idiopathic pulmonary fibrosis (IPF) and sarcoidosis showed significantly lower BCTs than unclassified ILD. Asbestosis patients showed significantly lower BCTs than nonspecific interstitial pneumonia (NSIP), cryptogenic organizing pneumonia (COP), connective tissue disease related ILD (CTD-ILD), sarcoidosis and unclassified ILD patients. COP patients showed significantly higher BCT than IPF, f-HP and sarcoidosis. Moreover, COP patients were best distinguished by BCT. ConclusionThe analysis of BAL features is currently included in the diagnostic algorithm of ILDs. BAL cell patterns and BCT index can provide useful information for distinguishing ILDs, reducing the need for invasive procedures. Integrated approaches to BAL analysis can improve the interpretation of results without further cost or loss of time.

Asthmatic Disease as an Underlying Cause of Dorsal Displacement of the Soft Palate in Horses

It is important to treat the upper and lower respiratory tracts as a single unit, as lower respiratory tract diseases can often cause upper respiratory functional disorders, whereas upper respiratory obstructions could be a factor in lower respiratory problems. The present study aimed to investigate the hypothesis that asthmatic diseases may be an underlying cause of dorsal displacement of the soft palate in horses. Pleasure or sport horses (n = 57) with a history of asthmatic disease were incorporated in the study. All horses were examined in the exacerbation phase of the asthmatic disease. Bronchoalveolar cytology and tracheal lavage bacteriology were performed in all cases. The upper respiratory tract was evaluated at rest in all horses and during exercising endoscopy in 11/57 with severe equine asthma. Binomial tests with P ≤ .05 significance were used to establish estimated intervals of the measured frequencies of dorsal displacement of the soft palate (DDSP) occurring in the studied groups. It was observed that more than 60% of horses with mild or moderate equine asthma and more than 79% of horses with severe equine asthma are presented with DDSP during resting endoscopy examination. During the exercising endoscopy, DDSP was detected in all cases of severe equine asthma. These findings support the proposed hypothesis that DDSP was common in horses with equine asthma. Both increasing negative pressure in the airways due to bronchoconstriction and inflammatory processes could be factors in the development of DDSP. The consequent step would be to investigate the same population of horses in the remission phase of the equine asthma.

The Significance of Bronchoalveolar Lavage Fluid Cytology in Diagnosing Lung Infiltrates in Children.

Aim:The aim of this research is to show why is it important in diagnosing children with lung infiltrates.Methods:Our study included 50 children with lung infiltrates during period 2005-2012, and was conducted on Pediatric Clinic of the University Clinical Center Sarajevo. We sent all cytological BAL analyses to the University Clinical Center Sarajevo. Cytology was performed by direct microscopy. BAL cytology was performed by the principle of sending samples for centrifuging, 12000 revolutions during a 10 min Shandon-cyto spin. Then the centrifuged sample is dried in the air during 1-2 hours, and is then dyed under the May-Grünwald-Giemsa staining, and analyzed under the Olympus BX41 microscope.Results:Nosocomial pneumonia has occurred in 32% children, acquired pneumonia in 38%, and 30% children had a lung infiltrates. 6 (12%) of children were younger then 1 year old, 23 (46%) children were between 1 to 5 years, 14 (28%) of children were between 5 to 10 ages, and 7 (14%) of children were between 10-15 ages. The most of the changes in observed children took place on the right lung, 34%, while 26% occurred on the left side, 22% were normal and 18% changes have affected both lungs, right and left. Percentage of cells in cytological smear in children with BAL were: cylindrical cells 28%, lung macrophage 26%, lymphocytes 17%, detritus 17% and phlegm 12%. Erythrocyte sedimentation rate (ESR) in children with BAL was up to 10-52%, to 50-30%, while ESR after first hour was above 50-18 %.Conclusion:Clinical parameters and local inflammation of the affected lobe are associated with positive bronchoalveolar cytology lavage findings.

Atividade da fosfatase alcalina no lavado broncoalveolar de equinos de policiamento montado no Estado do Rio de Janeiro

A utilidade da determinação das atividades enzimáticas no trato respiratório posterior como ferramenta diagnóstica já foi demonstrada em várias espécies. Nesse contexto, este trabalho teve por objetivo determinar a atividade da Fosfatase Alcalina (FAL) no lavado broncoalveolar (LBA) de equinos da Polícia Militar do Estado do Rio de Janeiro, comparando animais sadios com portadores assintomáticos de doença inflamatória das vias aéreas (DIVA). Para tal, foram avaliados 28 animais adultos, machos, sem histórico de doença respiratória nos dois meses anteriores ao estudo, com os resultados dos exames físicos e laboratoriais (FAL sanguínea, hematócrito, leucograma, proteína total e fibrinogênio plasmáticos) dentro dos parâmetros fisiológicos. Os equinos foram divididos em dois grupos de acordo com o resultado da citologia broncoalveolar. A determinação da atividade da FAL foi realizada por meio de espectrofotometria a partir de alíquotas do sobrenadante do LBA preservadas em nitrogênio líquido. Para a estimativa do fluido epitelial pulmonar e da atividade da FAL neste, foi realizada a correção da diluição provocada pelo lavado. Os equinos com contagem diferencial de tipos celulares compatível com DIVA apresentaram atividade de FAL no LBA menor, quando comparados aos animais sadios, podendo essa dosagem ser utilizada como complementação do diagnóstico da DIVA.

Efeitos do estresse da orquiectomia na citologia broncoalveolar de bezerros da raça Holandesa

A identificação do impacto que certas formas de estresse causam ao bem estar animal e equilíbrio orgânico, representa um desafio á adoção de boas práticas de criação. Assim, a presente pesquisa verificou o impacto de um desafio doloroso rotineiro dos bovinos na imunidade pulmonar e sistêmica. Avaliou-se hemograma e cortisol, em quatro momentos, sendo M1, M6, M7 e M8 (respectivamente sete dias antes e um, três e oito dias depois do desafio doloroso) e citologia broncolaveolar, obtida por broncoscopia, nos momentos M1, M6 e M8. Houve uma redução dos valores do eritrograma no primeiro dia após o desafio, compatível com anaplasmose e agravada pela perda de sangue durante a cirurgia e um influxo de leucócitos para a região pulmonar. Oito dias após o desafio, evidenciou-se aumento de cortisol, gerando uma leucocitose por neutrofilia e monocitose no sangue com provável redução de quimiotaxia para o pulmão, tornando o trato respiratório potencialmente mais susceptível a infecções, sugerindo que esta prática de manejo, mesmo acompanhado de protocolo analgésico, pode ser considerada um fator de risco a penumonias afetando o bem estar animal.

Association between the miRNA Signatures in Plasma and Bronchoalveolar Fluid in Respiratory Pathologies

The identification of new less invasive biomarkers is necessary to improve the detection and prognostic outcome of respiratory pathological processes. The measurement of miRNA expression through less invasive techniques such as plasma and serum have been suggested to analysis of several lung malignancies including lung cancer. These studies are assuming a common deregulated miRNA expression both in blood and lung tissue. The present study aimed to obtain miRNA representative signatures both in plasma and bronchoalveolar cell fraction that could serve as biomarker in respiratory diseases. Ten patients were evaluated to assess the expression levels of 381 miRNAs. We found that around 50% miRNAs were no detected in both plasma and bronchoalveolar cell fraction and only 20% of miRNAs showed similar expression in both samples. These results show a lack of association of miRNA signatures between plasma and bronchoalveolar cytology in the same patient. The profiles are not comparable; however, there is a similarity in the relative expression in a very small subset of miRNAs (miR-17, miR-19b, miR-195 and miR-20b) between both biological samples in all patients. This finding supports that the miRNAs profiles obtained from different biological samples have to be carefully validated to link with respiratory diseases.

Association between the miRNA signatures in plasma and bronchoalveolar fluid in respiratory pathologies.

The identification of new less invasive biomarkers is necessary to improve the detection and prognostic outcome of respiratory pathological processes. The measurement of miRNA expression through less invasive techniques such as plasma and serum have been suggested to analysis of several lung malignancies including lung cancer. These studies are assuming a common deregulated miRNA expression both in blood and lung tissue. The present study aimed to obtain miRNA representative signatures both in plasma and bronchoalveolar cell fraction that could serve as biomarker in respiratory diseases. Ten patients were evaluated to assess the expression levels of 381 miRNAs. We found that around 50% miRNAs were no detected in both plasma and bronchoalveolar cell fraction and only 20% of miRNAs showed similar expression in both samples. These results show a lack of association of miRNA signatures between plasma and bronchoalveolar cytology in the same patient. The profiles are not comparable; however, there is a similarity in the relative expression in a very small subset of miRNAs (miR-17, miR-19b, miR-195 and miR-20b) between both biological samples in all patients. This finding supports that the miRNAs profiles obtained from different biological samples have to be carefully validated to link with respiratory diseases.

Hereditary pulmonary alveolar proteinosis caused by recessive CSF2RB mutations

To the Editors: Pulmonary alveolar proteinosis (PAP) is a syndrome characterised by accumulation of surfactant in alveoli resulting in respiratory insufficiency 1. Surfactant homeostasis is critical for lung function and is tightly regulated, in part, by pulmonary granulocyte-macrophage colony-stimulating factor (GM-CSF), which is required for surfactant clearance by alveolar macrophages 2 and alveolar macrophage maturation 1. The effects of GM-CSF are mediated by cell-surface receptors composed of GM-CSF-binding α-chains and affinity-enhancing β-chains (encoded by CSF2RA and CSF2RB , respectively) 3. Ligand binding activates signalling via multiple pathways including the signal transducer and activator of phosphorylation (STAT)5 4. Disruption of GM-CSF signalling causes PAP by impairing surfactant catabolism in alveolar macrophages 1. In 90% of patients, PAP is caused by neutralising GM-CSF auto-antibodies 5, 6. Through the Rare Lung Diseases Network global PAP detection programme, we identified PAP caused by recessive CSF2RA mutations and developed novel diagnostic methods to identify patients with PAP caused by GM-CSF receptor dysfunction 4, 7. Herein, we report a case of hereditary PAP caused by disruption of GM-CSF receptor β-chain function. A previously healthy 9-yr-old female presented with bilateral pneumonia, followed 3 months later by progressive dyspnoea of insidious onset. The diagnosis of PAP was suggested by chest radiograph findings, high-resolution computed tomography and bronchoalveolar cytology, and was confirmed by surgical lung biopsy. Pulmonary histopathology was typical of primary PAP (fig. 1) and she was successfully treated by serial whole lung lavage therapy. Details of the case history are included in the online supplement. A GM-CSF auto-antibody test was negative and the serum GM-CSF level was increased (25.9 pg·mL−1) suggesting GM-CSF receptor dysfunction as the molecular basis of PAP 4, 7. A molecular evaluation was undertaken and included GM-CSF receptor detection, STAT-5 phosphorylation, CSF2RA …

Bronchoalveolar cytology for diagnosing pulmonary GVHD after bone marrow transplant in children

Cytological composition of bronchoalveolar lavage (BAL) fluid in pediatric bone marrow transplant (BMT) recipients with pulmonary complications has not been comprehensively described and BAL specific markers of pulmonary GVHD are lacking. The aim of this retrospective study was to assess the role of BAL in the diagnosis of pulmonary GVHD by comparing BAL cytological findings between pediatric allogenic BMT patients with pulmonary complications and oncology children receiving chemotherapy alone. Retrospective analysis of BAL specimens for cytology, total and differential cell counts and presence of infections. Seventeen BMT and 13 chemotherapy BAL were analyzed. BAL total cell count was increased but similar between groups (96.9 x 10(4) vs. 98.2 x 10(4), P = NS). BAL cellular composition differed considerably between groups with a significantly higher number of lymphocytes (18% vs. 6.25%, P = 0.03) and a significantly lower number of neutrophils (25.9% vs. 58%, P = 0.02) in BMT BAL specimens. Atypical epithelial cells were significantly more frequent (75% vs. 30.8%, P = 0.027), and significantly more severe (P = 0.01) in BMT patients. The presence and severity of atypia was not associated with infection or pneumotoxic drug exposure (P = NS). BAL cytology differs significantly between BMT and chemotherapy patients. The presence BAL lymphocytosis and severe epithelial cell atypia concomitantly to respiratory symptoms and GVHD in other organs may suggest the diagnosis of pulmonary GHVD. Prospective studies assessing the reliability of this finding combined with markers such as epithelial cell apoptosis and increased cytokines are needed.

The Use of Cardboard Bedding Material as Part of an Environmental Control Regime for Heaves-affected Horses: In Vitro Assessment of Airborne Dust and Aeroallergen Concentration and In Vivo Effects on Lung Function

This study aimed to test whether shredded cardboard is an appropriate minimum-dust bedding material for heaves-affected horses. Results of standardized in vitro measurement of airborne dust and aeroallergen concentrations of cardboard bedding were significantly lower than those of common bedding materials. Six heaves-affected horses in clinical remission after pasturing were stabled for two months on cardboard bedding and fed grass silage. Pulmonary function tests (PFT: ventilatory mechanics, arterial blood gases, airway inflammation scoring, bronchoalveolar cytology) were performed before, during and after this period and after stabling the horses in poor hygienic conditions. PFT values measured during and after the stabling period on cardboard bedding were not significantly different from those recorded after the period at pasture or from those of healthy horses, but were significantly different from those recorded in poor hygienic conditions. On basis of the in vitro and in vivo results it can be concluded that cardboard bedding, used in conjunction with low-dust forage, may be appropriate in the provision of minimum-dust management of heaves-affected horses.

Fine-needle aspiration as the initial diagnostic modality in malignant lung disease.

Cytologic detection of lung cancer is accepted, accurate, and time-honored. Typically, cytologic workup of a radiologic abnormality proceeds sequentially from sputum to bronchoalveolar cytology, and, if necessary, to fine-needle aspiration biopsy (FNA). Initial use of FNA in lung cancer diagnosis is controversial, but increasingly popular. We therefore decided to objectively assess current practice in cytologic lung cancer diagnosis at our institution. All pulmonary cytologic diagnoses for 1993 and the first half of 1994 were retrieved. Positive diagnoses were then used to access all patient data. Patients were stratified according to the specimen from which the first positive diagnosis was obtained. Of 542 pulmonary cytology specimens, 15% were sputa, 65% were bronchoalveolar, and 20% were FNAs. One hundred sixty-one of 172 malignant diagnoses were first diagnoses. Three percent of first malignant diagnoses were made from sputa, 47% were from lavages, and 50% were from FNAs. Although FNAs comprised just 20% of all pulmonary cytologies, 50% of all new malignant cytologic diagnoses were made by FNA. Initial use of FNA is successful, has a high diagnostic yield and low complication rate, and offers the most direct approach to diagnosis.