Effect of bronchoscopy on localization of gallium-67 citrate

Bronchoscopy, bronchoalveolar lavage (BAL), and 67Ga lung scans are frequently performed for diagnosis or follow-up of patients with sarcoidosis, interstitial pneumonitis, lymphoma, infections, and bronchogenic carcinoma. Because many patients undergo all 3 of these procedures, it is important to determine what effects bronchoscopy and/or BAL may have on gallium imaging. Because 67Ga accumulates in neutrophils at the site of an inflammatory lesion as well as in those circulating in the vascular compartment, it seems reasonable to postulate that bronchoscopy could cause migration of labeled neutrophils into the lung, resulting in false positive gallium scans. To test this hypothesis, we studied 5 patients with varying chronologic relationships of 67Ga injection, gallium scanning, and bronchoscopy with BAL. In all patients, the repeat 67Ga lung scans remained normal or showed no change after bronchoscopy and BAL. We conclude that bronchoscopy with or without BAL does not cause increased 67Ga uptake by the lung.