Open-lung biopsy guides therapy in children

Area of Science:

• Pediatric Pulmonology
• Thoracic Surgery
• Diagnostic Pathology

Background:

• Open-lung biopsy is an uncommon procedure in pediatric patients.
• Current indications and outcomes for pediatric open-lung biopsy are not well-established.

Purpose of the Study:

• To evaluate the modern indications and outcomes of open-lung biopsy in children.
• To compare biopsy practices and outcomes between two distinct time periods.

Main Methods:

• Retrospective review of 64 open-lung biopsies performed on 58 pediatric patients between 1976 and 1996.
• Biopsies were performed for diagnosing parenchymal lung disease, grading vasculopathy in pulmonary hypertension, and evaluating combined pulmonary hypertension and lung disease.
• Data were compared between biopsies performed from 1976-1989 and 1990-1996.

Main Results:

• The 1990-1996 period saw increased use in infants, patients with comorbid disease, and those requiring extracorporeal membrane oxygenation or ventilator support.
• A definitive diagnosis was achieved in 67% of cases, and the procedure altered the diagnostic workup in 98% of cases.
• In-hospital mortality was 30% and morbidity was 11%, with death associated with preoperative ventilator dependence and extracorporeal membrane oxygenation support.

Conclusions:

• Pediatric open-lung biopsy significantly alters diagnostic workup in most cases (98%).
• Recommended for children on extracorporeal membrane oxygenation for over two weeks or with combined pulmonary hypertension and parenchymal lung disease.
• Procedure is less beneficial in immunocompromised pediatric patients.