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The Bovine Lung in Biomedical Research: Visually Guided Bronchoscopy, Intrabronchial Inoculation and In Vivo Sampling Techniques
Published on: July 3, 2014
Open lung biopsy for diffuse interstitial lung disease in children
M E Coren1, A G Nicholson, P Goldstraw
1Dept of Paediatric Respiratory Medicine, The Royal Brompton Hospital, London, UK.
Insights
Open lung biopsy is a safe and effective procedure for diagnosing diffuse interstitial lung disease in children. It provides a high diagnostic yield, leading to significant changes in patient management and is the preferred biopsy technique.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Pediatric Pathology
Background:
- Diffuse interstitial lung disease (ILD) in children presents diagnostic challenges.
- Accurate diagnosis is crucial for effective management and prognosis.
- Minimally invasive biopsy techniques may not always provide sufficient diagnostic information.
Purpose of the Study:
- To evaluate the diagnostic contribution of open lung biopsy (OLB) in pediatric diffuse ILD.
- To assess the morbidity associated with OLB in children.
- To compare OLB safety and efficacy with other biopsy techniques.
Main Methods:
- Retrospective review of case notes and histology for pediatric patients (<18 years) undergoing OLB for diffuse ILD between 1991-1998.
- Analysis of procedure-related complications and need for intervention.
- Correlation of histological findings with clinical management changes.
Main Results:
- Open lung biopsy (OLB) achieved a high diagnostic yield (25/27 patients).
- Management plans were altered in 15/27 patients based on OLB results.
- Procedure-related morbidity was low, with only 3/27 patients requiring intervention; most patients were extubated in the operating room without chest drains.
Conclusions:
- Open lung biopsy (OLB) significantly contributes to the management of pediatric diffuse interstitial lung disease.
- OLB demonstrates a favorable safety profile with low morbidity in this pediatric cohort.
- Considering diagnostic accuracy and safety, OLB remains the preferred biopsy technique for pediatric diffuse ILD.
Abstract:
The aim of the study was to investigate the contribution that open lung biopsy makes to the management of children with diffuse interstitial lung disease and to review the procedure-related morbidity in comparison with published literature on other biopsy techniques. The authors reviewed the case notes and histology of patients under 18 yrs who had had an open lung biopsy in 1991-1998 for investigation of diffuse interstitial lung disease. The majority of patients returned from theatre breathing spontaneously and without an intercostal drain. Three out of 27 suffered a complication related to the biopsy that required intervention. A clear histological diagnosis was reached in 25/27 patients resulting in a change of management in 15/27. The most common histological patterns were nonspecific interstitial pneumonitis which generally had a favourable prognosis and follicular bronchiolitis/lymphocytic interstitial pneumonitis where prognosis was largely dependent on that of an underlying systemic disorder. It is concluded that open lung biopsy makes a substantial contribution to the management of diffuse interstitial lung disease in children and considering both diagnostic yield and safety, remains the biopsy technique of choice.
