Role of bronchoscopy for respiratory involvement in granulomatosis with polyangiitis and microscopic polyangiitis

Thomas Villeneuve; Grégoire Prévot; Grégory Pugnet; Gavin Plat; Valentin Héluain; Stanislas Faguer; Nicolas Guibert

doi:10.1183/23120541.00141-2023

Role of bronchoscopy for respiratory involvement in granulomatosis with polyangiitis and microscopic polyangiitis

ERJ Open Res. 2023 Sep 11;9(5):00141-2023. doi: 10.1183/23120541.00141-2023. eCollection 2023 Sep.

Authors

Thomas Villeneuve¹, Grégoire Prévot¹, Grégory Pugnet², Gavin Plat¹, Valentin Héluain¹, Stanislas Faguer³, Nicolas Guibert¹

Affiliations

¹ Pulmonology Department, University Hospital Center (CHU) of Toulouse, Toulouse, France.
² Internal Medicine Department, University Hospital Center (CHU) of Toulouse, Toulouse, France.
³ Department of Nephrology and Organ Transplantation, National Referral Center for Rare Renal Diseases, University Hospital Center (CHU) of Toulouse, Toulouse, France.

Abstract

Objectives: This study describes data from bronchoscopy performed at the diagnosis of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).

Methods: We conducted a retrospective study between 2004 and 2019 in patients aged >18 years with a diagnosis of microscopic polyangiitis (MPA) or granulomatosis with polyangiitis (GPA) who underwent bronchoscopy at onset of the disease. We collected bronchoalveolar lavage (BAL) and histological findings obtained during bronchoscopy.

Results: 274 patients with AAV were identified. Among 92 bronchoscopies, 62 were performed at diagnosis, and 58 procedures were finally analysed. Cough was more frequent in patients with MPA than GPA (p=0.02). The presence of endobronchial lesions (24.1%) was found to be significantly associated with GPA (p<0.0001) and proteinase 3-ANCA (p=0.01). The most frequent endobronchial lesions were inflammation and hyperaemia of the bronchial mucosa (50%), followed by stenoses (28%), ulcerations (21%) and mass-like granulomatosis (7%). The diagnostic yield of bronchial biopsies was useful for visible lesions (66.6% versus 0%; p=0.006). On BAL, diffuse alveolar haemorrhage (DAH) was detected in 31 (53.4%) patients and was more frequent in MPA patients (70.4% versus 38.7%; p=0.016). In 16.1% of DAH cases, BAL confirmed the diagnosis despite the absence of clinical or biological arguments. The incidence of microbial infections on BAL (38%) was similar between MPA and GPA (p=0.54).

Conclusion: Bronchoscopy is an informative procedure at the onset of AAV disease in patients with respiratory manifestations. Endobronchial lesions are more frequently found in GPA and should be biopsied. BAL can be used to confirm DAH or diagnose superadded infection.