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Activated CD8+ T Cells and NKT Cells in BAL Fluid Improve Diagnostic Accuracy in Sarcoidosis

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Abstract

Purpose

The clinical diagnosis of pulmonary sarcoidosis is based on the presence of noncaseating granulomas in an appropriate clinical setting with either bilateral hilar adenopathy and/or parenchymal infiltrates. Lymphocytosis with an increased CD4/CD8 T cell ratio in bronchoalveolar lavage fluid is supportive. We evaluated the diagnostic accuracy of a predictive binary logistic regression model in sarcoidosis based on sex, age, and bronchoalveolar lavage fluid cell profile with and without the inclusion of HLA-DR+ CD8+ T cells and natural killer T-cell fractions.

Methods

A retrospective analysis of differential cell counts and lymphocyte phenotypes by flow cytometry in bronchoalveolar lavage was performed in 183 patients investigated for possible diffuse parenchymal lung disease. A logistic regression model with age, sex, lymphocyte fraction, eosinophils, and CD4/CD8 ratio in bronchoalveolar lavage fluid (basic model) was compared with a final model, which also included fractions of HLA-DR+ CD8+ T cells and natural killer T cells. Diagnostic accuracy of the two models was assessed by receiver operating characteristic (ROC) curves.

Results

The area under the ROC curve for the basic and final model was 0.898 [95 % confidence interval (CI) 0.852–0.945] and 0.937 (95 % CI 0.902–0.972), respectively, p = 0.008.

Conclusions

Assessment of HLA-DR+ CD8+ T cell and natural killer T-cell fractions may improve diagnostic accuracy and further strengthen the importance of bronchoalveolar lavage in the diagnostic workup of sarcoidosis.

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Acknowledgments

Assistance provided by Gine Eggen and colleagues in the Unit for cytometry, Department of Immunology and Transfusion Medicine, St. Olavs University Hospital was greatly appreciated, and the unit’s expertise in flow cytometry has been invaluable to this study.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Thoracic Medicine, St. Olavs Hospital, Postboks 3250 Sluppen, 7006, Trondheim, Norway

    A. Tøndell & M. Sue-Chu

  2. Department of Immunology and Transfusion Medicine, St. Olavs Hospital, Trondheim, Norway

    A. Tøndell, A. D. Rø, M. Børset & T. Moen

  3. Department of Medical Biochemistry, St. Olavs Hospital, Trondheim, Norway

    A. Åsberg

  4. Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    A. Tøndell & M. Børset

  5. Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway

    T. Moen

  6. Department of Circulation and Imaging, Norwegian University of Science and Technology, Trondheim, Norway

    M. Sue-Chu

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  1. A. Tøndell
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  2. A. D. Rø
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Correspondence to A. Tøndell.

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Tøndell, A., Rø, A.D., Åsberg, A. et al. Activated CD8+ T Cells and NKT Cells in BAL Fluid Improve Diagnostic Accuracy in Sarcoidosis. Lung 192, 133–140 (2014). https://doi.org/10.1007/s00408-013-9527-8

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  • DOI: https://doi.org/10.1007/s00408-013-9527-8

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