Estudio de calidad y selección de muestras de lavado broncoalveolar (LBA) en neumopatías difusas
Quality study and screening of bronchoalveolar lavage samples
J. Martín Juan*, F. Valenzuela Mateos, G. Soto Campos, A. Segado Soriano, F. Rodríguez Panadero, J. Castillo Gómez
Servicio de Respiratorio. Hospital Universitario Virgen del Rocío. Sevilla
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"apellidos" => "Valenzuela Mateos" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Soto Campos" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Segado Soriano" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Rodríguez Panadero" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Castillo Gómez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Respiratorio. Hospital Universitario Virgen del Rocío. Sevilla" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Virgen de Valvanera, 19, Edif. Madrid 12.° A. 41018 Sevilla." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Quality study and screening of bronchoalveolar lavage samples" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "1994-11-14" "fechaAceptado" => "1996-02-13" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec546165" "palabras" => array:3 [ 0 => "Lavado broncoalveolar" 1 => "Calidad de muestras" 2 => "Enfermedad pulmonar intersticial" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec546164" "palabras" => array:3 [ 0 => "Bronchoalveolar lavage" 1 => "Quality samples" 2 => "Interstitial lung disease" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Uno de los requisitos esenciales en la técnica de LBA, cuando se utiliza con el fin concreto de estudiar la respuesta inmune o inflamatoria en patología intersticial pulmonar, es que las muestras obtenidas sean representativas del tracto respiratorio inferior. Por ello, la selección de muestras adecuadas es un paso obligado en el estudio de rutina.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Valorar la incidencia de muestras de LBA no idóneas para estudio citológico y determinar la relación entre parámetros relacionados con la técnica y patología subyacente con la calidad de especímenes.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 161 pacientes: 72 infectados por el VIH con infiltrados pulmonares difusos, 34 fibrosis pulmonar idiopàtica (FPI), 10 sarcoidosis, 10 neumonitis por hipersensibilidad, 19 con neumopatía intersticial asociada a enfermedades del colágeno, dos con eosinofilia pulmonar y 14 pacientes seleccionados como grupo control.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Para el estudio de calidad se realizó tinción de muestras de LBA con técnica de Wright-Giemsa modificada y se emplearon los criterios de selección descritos por Chamberlain et al. (1987). Resultaron no útiles para estudio el 53% de muestras en pacientes infectados por el VIH, el 35% en pacientes con fibrosis pulmonar idiopàtica y el 21% en neumopatía intersticial asociada a conectivopatías. En el resto, todas las muestras fueron útiles para estudio. La intolerancia del LBA con descenso del porcentaje de fluido recuperado se asoció significativamente con la calidad de muestras sobre todo en el grupo con FPI. Los hallazgos citológicos que invalidaron las muestras fueron diferentes entre grupos. Como dato común, las muestras inadecuadas mostraron una baja concentración celular. Por otro lado, la evidencia o no de infección asociada en pacientes infectados por el VIH, al contrario que en otras neumopatías, no parece ser un factor que determine por sí mismo la calidad de muestras.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Es previsible la obtención de un porcentaje importante de muestras de LBA no idóneas para estudio, sobre todo en neumopatía difusa asociada a infección VIH, FPI y neumopatía intersticial asociada a conectivopatías. Por otra parte, la tolerancia de la técnica, entre otros factores, influye en la calidad del espécimen y, por tanto, ha de tenerse en cuenta en la valoración de los hallazgos citológicos.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Falta por homogeneizar la aplicación de criterios de calidad entre los distintos grupos de trabajo y determinar si la exclusión de muestras no útiles repercute en la composición final de los grupos de estudio.</p></span>" ] "en" => array:1 [ "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Bronchoalveolar lavage (BAL) samples used to study immune or inflammatory response in interstitial lung disease must be representative of the lower respiratory tract. Thus, the selection of suitable samples must be part of routine practice.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To assess the incidence of unsuitable BAL samples used for cytology and to determine the relation between parameters related to underlying disease and the quality of samples.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">One hundred sixty-one patients were enrolled. Seventytwo were HIV positive and had diffuse pulmonary infiltrates, 34 had idiopathic pulmonary fibrosis (IPF), 10 had sarcoidosis, 10 had hypersensitivity pneumonitis, 19 had interstitial lung disease and collagen diseases and 2 had pulmonary eosinophilia. Fourteen individuals formed the control group.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The quality study was carried out by staining the BAL samples following a modified Wright-Giemsa technique and evaluating the samples by the selection criteria described by Chamberlain and colleagues (1987).</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">We identified unsuitable samples from 53% of the HIV positive patients, from 35% of the IPF patients and from 21% of the interstitial lung disease patients with associated connective tissue disease. In the other groups, all samples were suitable for analysis. Intolerance of BAL with decreasing percentage of fluid recovered was significantly associated with sample quality, particularly in the IPF group. The cytology results that invalidated the samples differed by group. In all groups, unsuitable specimens had low cell counts. The finding or not of evidence of associated infectionin HIV-infected patients, on the other hand, did not appear to determine sample quality in and of itself, although it did in samples related to other entities.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">We can predict that a high rate of unsuitable BAL samples will come mainly from patients with diffuse lung disease associated to HIV infection, IPF and interstitial lung disease with associated connective tissue disease. Tolerance to the technique influences quality of the specimen obtained and, therefore, should be taken into account in interpreting the findings of cytology.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The criteria applied by the various teams using BAL should be unified, and it should be determined whether the exclusion of inappropriate samples affects the final composition of study groups.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of proteins and respiratory cels obtained from human lungs by bronchial lavage" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.Y. Reynolds" 1 => "H.H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 1 | 6 |
| 2024 October | 56 | 16 | 72 |
| 2024 September | 42 | 17 | 59 |
| 2024 August | 56 | 37 | 93 |
| 2024 July | 36 | 27 | 63 |
| 2024 June | 65 | 22 | 87 |
| 2024 May | 42 | 28 | 70 |
| 2024 April | 36 | 22 | 58 |
| 2024 March | 36 | 30 | 66 |
| 2024 February | 30 | 26 | 56 |
| 2024 January | 0 | 1 | 1 |
| 2023 December | 0 | 3 | 3 |
| 2023 November | 0 | 4 | 4 |
| 2023 October | 0 | 8 | 8 |
| 2023 September | 0 | 2 | 2 |
| 2023 July | 0 | 2 | 2 |
| 2023 March | 4 | 4 | 8 |
| 2023 February | 33 | 23 | 56 |
| 2023 January | 31 | 32 | 63 |
| 2022 December | 39 | 23 | 62 |
| 2022 November | 41 | 18 | 59 |
| 2022 October | 32 | 26 | 58 |
| 2022 September | 31 | 26 | 57 |
| 2022 August | 40 | 45 | 85 |
| 2022 July | 37 | 37 | 74 |
| 2022 June | 35 | 32 | 67 |
| 2022 May | 51 | 28 | 79 |
| 2022 April | 42 | 25 | 67 |
| 2022 March | 38 | 36 | 74 |
| 2022 February | 35 | 29 | 64 |
| 2022 January | 35 | 35 | 70 |
| 2021 December | 32 | 46 | 78 |
| 2021 November | 29 | 40 | 69 |
| 2021 October | 31 | 43 | 74 |
| 2021 September | 32 | 34 | 66 |
| 2021 August | 27 | 30 | 57 |
| 2021 July | 28 | 45 | 73 |
| 2021 June | 30 | 38 | 68 |
| 2021 May | 41 | 27 | 68 |
| 2021 April | 43 | 36 | 79 |
| 2021 March | 38 | 21 | 59 |
| 2021 February | 31 | 9 | 40 |
| 2021 January | 31 | 20 | 51 |
| 2020 December | 29 | 18 | 47 |
| 2020 November | 19 | 17 | 36 |
| 2020 October | 27 | 12 | 39 |
| 2020 September | 20 | 16 | 36 |
| 2020 August | 28 | 11 | 39 |
| 2020 July | 45 | 11 | 56 |
| 2020 June | 23 | 25 | 48 |
| 2020 May | 32 | 12 | 44 |
| 2020 April | 32 | 10 | 42 |
| 2020 March | 31 | 18 | 49 |
| 2020 February | 36 | 18 | 54 |
| 2020 January | 39 | 27 | 66 |
| 2019 December | 29 | 40 | 69 |
| 2019 November | 12 | 11 | 23 |
| 2019 October | 22 | 25 | 47 |
| 2019 September | 16 | 33 | 49 |
| 2019 August | 14 | 15 | 29 |
| 2019 July | 20 | 40 | 60 |
| 2019 June | 18 | 18 | 36 |
| 2019 May | 24 | 31 | 55 |
| 2019 April | 35 | 45 | 80 |
| 2019 March | 12 | 15 | 27 |
| 2019 February | 15 | 11 | 26 |
| 2019 January | 10 | 13 | 23 |
| 2018 December | 15 | 15 | 30 |
| 2018 November | 24 | 18 | 42 |
| 2018 October | 34 | 15 | 49 |
| 2018 September | 20 | 7 | 27 |
| 2018 May | 8 | 1 | 9 |
| 2018 April | 10 | 6 | 16 |
| 2018 March | 4 | 7 | 11 |
| 2018 February | 10 | 12 | 22 |
| 2018 January | 8 | 8 | 16 |
| 2017 December | 10 | 16 | 26 |
| 2017 November | 8 | 16 | 24 |
| 2017 October | 7 | 8 | 15 |
| 2017 September | 10 | 11 | 21 |
| 2017 August | 11 | 10 | 21 |
| 2017 July | 13 | 5 | 18 |
| 2017 June | 14 | 27 | 41 |
| 2017 May | 13 | 15 | 28 |
| 2017 April | 11 | 26 | 37 |
| 2017 March | 7 | 19 | 26 |
| 2017 February | 6 | 15 | 21 |
| 2017 January | 9 | 12 | 21 |
| 2016 December | 29 | 16 | 45 |
| 2016 November | 44 | 23 | 67 |
| 2016 October | 39 | 28 | 67 |
| 2016 September | 41 | 17 | 58 |
| 2016 August | 37 | 7 | 44 |
| 2016 July | 33 | 6 | 39 |
| 2016 June | 39 | 10 | 49 |
| 2016 May | 35 | 6 | 41 |
| 2016 April | 27 | 0 | 27 |
| 2016 March | 18 | 0 | 18 |
| 2016 February | 23 | 2 | 25 |
| 2016 January | 25 | 4 | 29 |
| 2015 December | 46 | 15 | 61 |
| 2015 November | 45 | 11 | 56 |
| 2015 October | 12 | 1 | 13 |
| 2015 September | 1 | 0 | 1 |
| 2015 June | 1 | 0 | 1 |
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