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Diagnosis of Pulmonary Alveolar Proteinosis
Usefulness of Papanicolaou-Stained Smears of Bronchoalveolar Lavage Fluid
Chung-Wei Chou, MD;
Fang-Chi Lin, MD;
Su-Mei Tung, BS;
Rong-Dih Liou, BN;
Shi-Chuan Chang, MD, PhD
Arch Intern Med. 2001;161:562-566.
Background The globules (stained green, orange, or orange in the center coated
with a green rim) seen in Papanicolaou-stained smears of bronchoalveolar lavage
fluid are suggested to be characteristic of pulmonary alveolar proteinosis
(PAP).
Objective To evaluate the usefulness of Papanicolaou-stained smears of bronchoalveolar
lavage fluid in aiding a diagnosis of PAP.
Methods Papanicolaou-stained smears of bronchoalveolar lavage fluid obtained
from 7 patients (5 idiopathic, 2 secondary) with PAP were evaluated. To serve
as controls, the smears of 11 normal subjects and 128 patients with other
pulmonary disorders were also examined. The findings on the presence and number
of globules were recorded. To differentiate PAP from other pulmonary disorders,
the highest globule value obtained from the control group was chosen as the
cutoff point.
Results The characteristic globules were not found in normal subjects and only
found in 6 of 128 patients with other pulmonary disorders. Their clinical
diagnoses were Sjögren syndrome in 2 cases; polymyositis, idiopathic
pulmonary fibrosis, asbestosis, and hypersensitivity pneumonitis in 1 case
each. The numbers of globules in these 6 patients were 1, 3, 17, 7, 3, and
2. In contrast, more than 100 globules were found in all patients with PAP.
The number of globules was highly sensitive and specific in aiding a diagnosis
of PAP when the cutoff value was set at 18.
Conclusion The globules seen in Papanicolaou-stained smears of bronchoalveolar
lavage fluid may be valuable in aiding a diagnosis of PAP, especially when
the number of globules is more than 18.
From the Chest Department, Veterans General Hospital–Taipei (Drs
Chou, Lin, and Chang and Mss Tung and Liou), and the School of Medicine, National
Yang-Ming University (Dr Chang), Taipei, Taiwan.
Corresponding author: Shi-Chuan Chang, MD, Chest Department, Veterans
General Hospital–Taipei, 201 Section 2, Shih-Pai Road, Shih-Pai, Taipei,
Taiwan 112, Republic of China (e-mail: scchang{at}vghtpe.gov.tw).
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