Predictive value of bronchoalveolar lavage cell analysis in sarcoidosis

Patients with histopathologically proved sarcoidosis were studied serially by means of bronchoalveolar lavage, initially at the time of diagnosis and then six and 12 months later. Two years later they were evaluated by chest radiography and lung function tests and classified in terms of recovery or progression over the previous two years. The recovery of lymphocytes and granulocytes in lavage fluid was of limited prognostic value for persistent lung disease. In contrast, patients with increased numbers of mast cells recovered by lavage were more likely to deteriorate. Significantly increased mast cell counts (greater than or equal to 0.5% of total cells recovered) were seen in at least one lavage investigation in 15 of the 16 patients with more active and progressive disease, but in only eight of 23 patients with inactive disease (p less than 0.001). A persistent increase of mast cells on serial measurement occurred in nine of the 16 patients with active disease and in four of the 23 patients in whom the disease was inactive (p less than 0.02). The finding in the two subsequent lavages of lymphocytosis (lymphocytes greater than 30% of recovered cells) or neutrophilia (neutrophils greater than 15%) combined with mastocytosis (mast cells greater than or equal to 0.5%) occurred in nine of the 16 patients with active disease but in no patients with inactive disease.