Transbronchial biopsy in chronic hypersensitivity pneumonitis

Main Article Content

Andre Bezerra Botelho
Rimarcs Gomes Ferreira
Ester N. A. M. Coletta
Milena Tenório Cerezoli
Rafaela Boaventura Martins
Paula Silva Gomes
Andrea Gimenez
Luiz Hirotoshi Ota
Maria Raquel Soares
Carlos Alberto Castro Pereira


Hypersensitivity Pneumonitis, Transbronchial Biopsy, Bronchoalveolar Lavage


Introduction: The diagnosis of chronic hypersensitivity pneumonitis (cHP) is based on clinical data, tomographic patterns and, in some cases, on pathologic findings. The role of bronchoscopy is uncertain, especially in the fibrotic form. Aim: To analyze the yield of transbronchial biopsy (TBBx) in patients with cHP according to tomographic findings and to evaluate the importance of bronchoalveolar lavage (BAL) in the diagnostic approach. Methods: A retrospective study of patients with cHP who underwent TBBx in São Paulo, Brazil. The  TBBx findings were classified as characteristic (granulomas and/or multinucleated giant cells, associated or not with peribronchiolar infiltration of lymphocytes and plasma cells and bronchiolocentric distribution) and supportive (data indicative of small airway injury: peribronchiolar metaplasia, organizing pneumonia, and intra-alveolar foamy macrophages). Results: One hundred nine patients were included. The presence of characteristic findings of HP were seen in 15 cases (13.8%) and supportive findings in 33 (30.2%), with a total yield of 44%. The pathologic characteristic findings were more common in cases without fibrosis on high-resolution computed tomography (HRCT) (24.2% vs. 9.2%, p= 0.036), whereas the presence of supportive findings was more common in fibrotic HP (38.1% vs. 12.1%, p= 0.007). Fifty-two patients had differential cytology on BAL. Lymphocytosis (> 20%) was present in 51.9% of the patients. There was no difference in the median of the lymphocytes according to tomographic findings indicative or not of fibrosis on HRCT. Conclusion: TBBx has a role to the diagnosis of HP and in association with BAL should be used as the initial option in the investigation of the disease.


Download data is not yet available.
Abstract 153 | PDF Downloads 51


1. Soares MR, Pereira CAC, Botelho A, Gimenez A, Beraldo B, Ferraz C, et al. Multicenter registry of interstitial lung diseases in Brazil. ERJ 2019; 54 (supll 6); A3634.
2. Pereira CA, Gimenez A, Kuranishi L, Storrer K. Chronic hypersensitivity pneumonitis. J Asthma Allergy. 2016; 9:171-81.
3. De Sadeleer LJ, Hermans F, De Dycker E, Yserbyt J, Verschakelen JA, Verbeken EK, et al. Effects of Corticosteroid Treatment and Antigen Avoidance in a Large Hypersensitivity Pneumonitis Cohort: A Single-Centre Cohort Study. J Clin Med. 2018;8(1).

4. Salisbury ML, Myers JL, Belloli EA, Kazerooni EA, Martinez FJ, Flaherty KR. Diagnosis and Treatment of Fibrotic Hypersensitivity Pneumonia. Where We Stand and Where We Need to Go. Am J Respir Crit Care Med. 2017;196(6):690-9.

5. Morisset J, Johannson KA, Jones KD, Wolters PJ, Collard HR, Walsh SLF, et al. Identification of Diagnostic Criteria for Chronic Hypersensitivity Pneumonitis: An International Modified Delphi Survey. Am J Respir Crit Care Med. 2017.

6. Vasakova M, Morell F, Walsh S, Leslie K, Raghu G. Hypersensitivity Pneumonitis: Perspectives in Diagnosis and Management. Am J Respir Crit Care Med. 2017;196(6):680-9.

7. Hanak V, Golbin JM, Hartman TE, Ryu JH. High-resolution CT findings of parenchymal fibrosis correlate with prognosis in hypersensitivity pneumonitis. Chest. 2008;134(1):133–138.

8. Cormier Y, Bélanger J, LeBlanc P, Laviolette M. Bronchoalveolar lavage in farmers' lung disease: diagnostic and physiological significance. Br J Ind Med. 1986;43(6):401-5.

9. Yang R, Scott J, Moran-Mendoza 0. Bronchoalveolar Lavage Differential in Chronic Hypersensitivity Pneumonitis: A Meta-Analysis. Am J Respir Crit Care Med 2017;195:A1592.

10. Lima MS, Coletta EN, Ferreira RG, Jasinowodolinski D, Arakaki JSO, Rodrigues RC et al. Acute and chronic hypersensitivity pneumonitis: histopathological patterns and survival. Respir Med. 2009;103(4):508–515.

11. Wright JL, Churg A, Hague CJ, Wong A, Ryerson CJ. Pathologic separation of idiopathic pulmonary fibrosis from fibrotic hypersensitivity pneumonitis. Mod Pathol. 2019;10.1038/s41379-019-0389-3. doi:10.1038/s41379-019-0389-3.

12. Adams TN, Newton CA, Batra K, Abu-Hijleh M, Barbera T, Torrealba J, et al. Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Hypersensitivity Pneumonitis. Lung. 2018;196(5):617-22.

13. Salisbury ML, Gross BH, Chughtai A, Chughtai A, Sayyouh M, Kazerooni2et EA, et al. Development and validation of a radiological diagnosis model for hypersensitivity pneumonitis. Eur Respir J. 2018;52(2):1800443.

14. Silva CI, Müller NL, Lynch DA, et al. Chronic hypersensitivity pneumonitis: differentiation from idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia by using thin-section CT. Radiology. 2008;246(1):288–297.

15. Clinical guidelines and indications for bronchoalveolar lavage (BAL): Report of the European Society of Pneumology Task Group on BAL. Eur Respir J. 1990;3(8):937-76.

16. Morell F, Roger A, Reyes L, Cruz MJ, Murio C, Muñoz X. Bird fancier's lung: a series of 86 patients. Medicine (Baltimore). 2008;87(2):110-30.

17. Hanak V, Kalra S, Aksamit TR, Hartman TE, Tazelaar HD, Ryu JH. Hot tub lung: presenting features and clinical course of 21 patients. Respir Med. 2006;100(4):610-5.

18. Hanak V, Golbin JM, Ryu JH. Causes and presenting features in 85 consecutive patients with hypersensitivity pneumonitis. Mayo Clin Proc. 2007;82(7):812-6.

19. Barrios RJ. Hypersensitivity pneumonitis: histopathology. Arch Pathol Lab Med. 2008;132(2):199-203.

20. Fukuoka J, Franks TJ, Colby TV, Flaherty KR, Galvin JR, Hayden D, et al. Peribronchiolar metaplasia: a common histologic lesion in diffuse lung disease and a rare cause of interstitial lung disease: clinicopathologic features of 15 cases. Am J Surg Pathol. 2005;29(7):948-54.
21. Raghu G, Remy-Jardin M, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, et al. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. 2018;198(5):e44-e68.

22. Sterclova M, Vasakova M, Dutka J, Kalanin J. Extrinsic allergic alveolitis: comparative study of the bronchoalveolar lavage profiles and radiological presentation. Postgrad Med J. 2006;82(971):598-601.

Most read articles by the same author(s)