What question did this study set out to answer?

This study aims to evaluate the effectiveness of bronchoalveolar lavage cytology in diagnosing interstitial lung diseases.

February 28, 2026Open Access

Role of Bronchoalveolar Lavage in Interstitial Lung Disease Diagnosis: A Cytological Perspective

Key Points

This study aims to evaluate the effectiveness of bronchoalveolar lavage cytology in diagnosing interstitial lung diseases.
Conducted an observational study with 100 ILD patients over a year.
Enrolled 31 patients requiring multidisciplinary diagnosis for ILD.
Processed bronchoalveolar lavage fluid using cytocentrifugation and staining techniques.
Assessed differential cell counts in BAL fluid.
Performed endobronchial biopsy and ultrasound-guided aspiration in select cases.
Mean age of patients was 41.2 years, with a majority being female.
Common ILD subtypes included sarcoidosis, CTD-ILD, idiopathic nonspecific interstitial pneumonia, and hypersensitivity pneumonitis.
BAL showed lymphocytosis in sarcoidosis (41.8%) and chronic hypersensitivity pneumonitis (56.7%).
Neutrophilia was also observed in some cases, not necessarily indicating infection.
BAL findings aligned with final diagnoses, supporting bronchoalveolar lavage's predictive value.

Abstract

Abstract Objectives: Interstitial lung diseases (ILDs) are a heterogeneous group of pulmonary disorders requiring a multidisciplinary diagnostic approach. Bronchoalveolar lavage (BAL) is a minimally invasive procedure that provides cellular insights into lung pathology. This study evaluates the role of BAL cytology in ILD cases. Materials and Methods: This observational study was conducted at a tertiary care health care center, from April 2023 to June 2024. A total of 100 ILD patients were enrolled, out of which 31 patients who required multidisciplinary diagnosis (MDD) for a final diagnosis of ILD were included. BAL fluid was processed using cytocentrifugation and stained with Giemsa and Papanicolaou stains, and differential cell count patterns (cellular analysis) were assessed in 400 cells. In cases of sarcoidosis, endobronchial biopsy was performed in five cases, and endobronchial ultrasound-guided transbronchial needle aspiration was performed in nine cases. The MDD approach incorporated clinical features, high-resolution computed tomography, biochemical, microbiological, biopsy, and cytology findings. Results: The mean age of patients was 41.2 ± 12.2 years, with a female predominance (74.2%). The distribution of ILD subtypes included sarcoidosis (45.2%), connective tissue disease-associated interstitial lung disease (CTD-ILD) (25.8%) idiopathic nonspecific interstitial pneumonia (6.5%), and hypersensitivity pneumonitis (HP) (22.6%). BAL cellular analysis showed lymphocytosis in sarcoidosis (41.8%) and chronic HP (56.7%) with neutrophilia (mean value >20%). The CTD-ILD cellular pattern is similar to that of sarcoidosis. BAL findings corroborated with the final diagnoses in cases with multiple differentials. Conclusion: BAL cellular analysis is a valuable tool in the MDD approach to ILD diagnosis. The presence of lymphocytosis in BAL commensurates with sarcoidosis and chronic HP diagnosis. The presence of concurrent neutrophilia in such cases may not necessarily be considered in lines of an infective etiology or acute exacerbation.

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