Diagnostic value of combined bronchoalveolar lavage and transbronchial lung biopsy

The aim of our study was to assess the diagnostic value of combined transbronchial lung biopsy (TBB) and bronchoalveolar lavage (BAL) in non-immunosuppressed patients, who underwent routine bronchoscopy for evaluation of interstitial lung disease. We examined routinely sampled and processed material from 87 patients from two peripheral pulmological centers and compared the lavage and biopsy results to the final clinical outcome. 22 of these patients showed no evidence of interstitial lung disease during the course of follow-up. Sufficient lung parenchyma was present in 81 of 91 biopsy specimens (including four repeat biopsies), and 79 of 91 BAL samples were considered adequate. The combination of BAL and TBB was more efficient (efficiency 80.3% vs. 67.9% in TBB and 64.6% in BAL) than either method alone. Sensitivity showed a similar increase from 58.8% in TBB and 73.9% in BAL to 79.5% for both combined. Specificity for BAL was a low 60.7% due to contamination by inflammatory cells from upper airways, whereas specificity for TBB was 100%. We conclude that the combination of bronchoalveolar lavage and transbronchial lung biopsy is a valuable tool in the evaluation of interstitial lung disease and should be employed whenever possible.