Our approach to the diagnosis of suspected chronic beryllium disease (CBD)

HRCT: high resolution computed tomography; BeLPT: beryllium lymphocyte proliferation test; PFT: pulmonary function test; BAL: bronchoalveolar lavage; ILD: interstitial lung disease; TB: tuberculosis; TST: tuberculin skin test; IGRA: interferon gamma release assay.
* Features that may warrant evaluaton for other causes prior to evalutaion for CBD: Fever, weight loss, night sweats, extrapulmonary manifestations, history of TB exposure or positive TST or IGRA, and HRCT findings of prominent hilar or mediastinal adenopathy.
¶ BeLPT is performed at a reference laboratory (eg, National Jewish Health, Cleveland Clinic, or ORISE Beryllium Testing Laboratory). It is advisable to contact referral laboratory prior to sending samples. In a screening setting, two separate positive BeLPT results (either blood or BAL) are needed to confirm sensitization. For symptomatic patients with an abnormal HRCT, a single positive BeLPT is sufficient to conclude sensitization.
Δ Blood BeLPT may be falsely negative in approximately 20 percent of patients with CBD.
◊ Perform BAL for BeLPT prior to any biopsy procedures, in RML or lingula if diffuse involvement on HRCT. Otherwise, perform BAL in area of abnormality. Typically, 4 successive 60 mL saline lavages are performed. If return is <50 mL, perform additional lavage at a separate site. Refer to UpToDate content for details of processing BAL sample.
§ Obtain 4 to 6 endobronchial biopsies from area of erythematous mucosa or at main carina and a secondary carina. Obtain transbronchial biopsies from area of involved lung, but not in area of BAL. Aim for 8 to 10 transbronchial biopsies (as tolerated by the patient). Surgical lung biopsy rarely needed to make a diagnosis of CBD.