• Amanda Grant-Orser, Michael Asmussen, Daniel-Costin Marinescu, Cameron J Hague, Nestor L Muller, Darra T Murphy, Andrew Churg, Joanne L Wright, Amna Al-Arnawoot, Ana-Maria Bilawich, Patrick Bourgouin, Gerald Cox, Celine Durand, Tracy Elliot, Jennifer Ellis, Jolene H Fisher, Derek Fladeland, Gillian C Goobie, Zachary Guenther, Ehsan Haider, Nathan Hambly, James Huynh, Geoffrey Karjala, Nasreen Khalil, Martin Kolb, Jonathon Leipsic, Stacey Lok, Sarah MacIsaac, Micheal McInnis, Helene Manganas, Veronica Marcoux, John Mayo, Julie Morisset, Ciaran Scallan, Tony Sedlic, Shane Shapera, Kelly Sun, Victoria Tan, Alyson W Wong, Boyang Zheng, Christopher J Ryerson, and Kerri A Johannson.
• Department of Medicine, University of Calgary, Calgary, AB, Canada. Electronic address: Amanda.grant-orser@mail.mcgill.ca.
• Chest. 2024 Aug 22.

BackgroundBronchoalveolar lavage (BAL) cellular analysis is often recommended during the initial diagnostic evaluation of fibrotic interstitial lung disease (ILD). Despite recommendation for its use, between-center heterogeneity exists and supportive data concerning the clinical utility and correlation of BAL findings with radiologic features or patterns remain sparse.Research QuestionIn patients with fibrotic ILD, are BAL findings associated with radiologic features, patterns, and clinical diagnoses?Study Design And MethodsPatients with fibrotic ILD who underwent BAL for diagnostic evaluation and who were enrolled in the prospective Canadian Registry for Pulmonary Fibrosis were re-reviewed in a standardized multidisciplinary discussion (MDD). BAL was categorized according to guideline-recommended thresholds, and using thresholds of lymphocytosis > 20% and neutrophils > 4.5%. High-resolution CT (HRCT) scans were scored (blinded to clinical data) for specific features and percentage lung involvement. Radiologists classified HRCT scans according to guideline-defined patterns for idiopathic pulmonary fibrosis and fibrotic hypersensitivity pneumonitis (fHP); then, MDD diagnoses were assigned, considering all available data.ResultsBronchoscopy with cellular analysis was performed in 209 of 1,593 patients (13%). Lymphocyte % was weakly negatively correlated with total fibrosis % (r = -0.16, P = .023) but not statistically significantly correlated with ground glass opacity % (r = 0.01, P = .94). A mixed BAL pattern was the most frequent in all radiologic patterns (range, 45%-69%), with a minority classifiable according to BAL guidelines. BAL lymphocytosis appeared with similar frequency across HRCT patterns of fHP (21%) and usual interstitial pneumonia (18%). Only 5% of patients with MDD-based fHP had a guideline-defined isolated lymphocytosis > 15%.InterpretationBAL cellular analyses did not significantly correlate with radiologic features, guideline patterns, or MDD-based diagnoses. Ground glass opacities are often interpreted to represent pulmonary inflammation, but were not associated with BAL lymphocytosis in this cohort.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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