Uniformity of Bronchoalveolar Lavage in Patients with Pulmonary Sarcoidosis

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Abstract
Sarcoidosis is a granulomatous disease of unknown cause characterized by a lymphocytic alveolitis. Previous studies have shown that the inflammatory cell population of the distal lung units of patients with this disorder can be accurately assessed using bronchoalveolar lavage (BAL). The present study evaluated the uniformity of BAL between different sites of the lung in patients with sarcoidosis. In general, there was a good correlation between sites for percentages of lymphocytes (LYM) r = 0.750, p < 0.0001), LYM number (r = 0.356, p = 0.0007), percentages of neutrophils (NEUT) (r = 0.917, p < 0.0001), NEUT number (r = 0.999, p < 0.0001), and macrophage (MAC) number (r = 0.858, p < 0.001). Despite the good overall correlation we found that 43% of the patients with high percent LYM (> 30%) had this finding on one side only. These patients did not differ from the group as a whole based on radiographic stage of their disease but did differ in the number of radiographs demonstrating focal infiltrates (2 of 28 patients with both sides < 30% LYM, 2 of 14 with both sides > 30% LYM, and 4 of 9 with only side > 30% LYM p < 0.05 by chi-square); and in each situation the highest percent LYM was seen on the side with focal changes on the chest radiograph. In addition, as a group, the patients with bilateral > 30% LYM had a lower percent predicted TLC (p < 0.05 compared with those with unilateral > 30% LYM and p < 0.01 compared with those with bilateral < 30% LYM) and DLCO (p < 0.01 compared with both groups). Similar groups defined by MAC number, though, did not differ from one another in any of the pulmonary function tests. These findings suggest that potentially useful information can be gained by the lavage of more than one site in patients with sarcoidosis, that these patients are not easily recognized prior to BAL, and that patients with bilateral > 30% LYM have worse pulmonary function as a group than do those with a bilateral or unilateral low LYM recovery.