Proliferative Response of Bronchoalveolar Lymphocytes to Beryllium

Abstract

Study Objective: To ascertain whether measuring the proliferative response of bronchoalveolar lymphocytes to beryllium salts is useful for diagnosing chronic beryllium disease. Design: Prospective case series compared to normal volunteers and patients with sarcoidosis. Setting: University referral center. Patients: Twenty-three consecutive beryllium workers were evaluated. Fourteen had chronic beryllium disease diagnosed on the basis of histologic evidence of a progressive pulmonary granulomatosis. Four had biopsy evidence of non-beryllium disease. Three had probable chronic beryllium disease but did not have lung biopsies. Two did not have biopsies and had basilar fibrosis on chest roentgenogram suggestige of non-beryllium lung disease. These patients were compared with 6 normal volunteers and 16 patients with sarcoidosis. Measurements and Main Results: Bronchoalveolar lavage was done and the proliferative response of the lung cells to two beryllium salts was tested. a positive proliferative test was defined as a stimulation index of more than five on two determinations. The sensitivity of this test was 100% in the 14 patients with definite chronic beryllium disease. The specificity of the test was also 100% among the normal volunteers and the 16 patients with sarcoidosis. The test was positive in none of the four patients with biopsy evidence of non-beryllium disease, none out of two patients with lower lobe fibrosis suggestive of non-beryllium disease, and all of three patients with probable chronic beryllium lung disease. Conclusions: The proliferative response of bronchoalveolar lymphocytes to beryllium appears to be a useful test for chronic berylium disease.