The CD4/CD8 ratio in BAL fluid is highly variable in sarcoidosis

Patients with pulmonary sarcoidosis frequently have increased numbers of lymphocytes and a high ratio of CD4+ to CD8+ T-lymphocytes (CD4/CD8 ratio) in bronchoalveolar lavage (BAL) fluid. Some investigators have suggested that these parameters can be used to distinguish sarcoidosis from other types of interstitial lung disease with a high degree of reliability. However, we hypothesized that the BAL CD4/CD8 ratio measured during the initial diagnostic evaluation of patients with biopsy-proven sarcoidosis is highly variable. BAL lymphocytes were analysed via flow cytometry to determine the CD4/CD8 ratio in a population of 86 patients with histological and clinical evidence of sarcoidosis, who underwent BAL as part of their initial diagnostic evaluation. In these patients, the CD4/CD8 ratio ranged 0.5-37.3, with a median value of 3.35 (mean 6.49). The CD4/CD8 ratio was greater than 4 in only 36 (42%) subjects. Ten patients (12%) had a CD4/CD8 ratio less than 1. The distribution of CD4/CD8 ratios was similar in the presence or absence of BAL lymphocytosis. In conclusion, the CD4/CD8 ratio in bronchoalveolar lavage fluid is highly variable in biopsy-proven sarcoidosis. Bronchoalveolar lavage lymphocyte subset determination is a diagnostic test with low sensitivity for this disease.

This article has been cited by other articles:

				A U Wells, N Hirani, and on behalf of the BTS Interstitial Lung Disease Gui Interstitial lung disease guideline Thorax, September 1, 2008; 63(Suppl_5): v1 - v58. [Full Text] [PDF]

				M.W. Ziegenhagen, M.E. Rothe, M. Schlaak, and J. Muller-Quernheim Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis Eur. Respir. J., March 1, 2003; 21(3): 407 - 413. [Abstract] [Full Text] [PDF]

				M. Reynaud-Gaubert, P. Thomas, R. Gregoire, M. Badier, P. Cau, J. Sampol, R. Giudicelli, and P. Fuentes Clinical utility of bronchoalveolar lavage cell phenotype analyses in the postoperative monitoring of lung transplant recipients Eur. J. Cardiothorac. Surg., January 1, 2002; 21(1): 60 - 66. [Abstract] [Full Text] [PDF]

				T. Takahashi, A. Azuma, S. Abe, O. Kawanami, K. Ohara, and S. Kudoh Significance of lymphocytosis in bronchoalveolar lavage in suspected ocular sarcoidosis Eur. Respir. J., September 1, 2001; 18(3): 515 - 521. [Abstract] [Full Text] [PDF]

				G. Raghu, Y. N. Mageto, D. Lockhart, R. A. Schmidt, D. E. Wood, and J. D. Godwin The Accuracy of the Clinical Diagnosis of New-Onset Idiopathic Pulmonary Fibrosis and Other Interstitial Lung Disease: A Prospective Study Chest, November 1, 1999; 116(5): 1168 - 1174. [Abstract] [Full Text] [PDF]