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Evaluation of the usefulness of open lung biopsies
S Gururangan1, R A Lawson, P H Jones
1Department of Paediatric Oncology, Royal Manchester Children's Hospital, England.
Insights
Open lung biopsy (OLB) is a valuable diagnostic tool for identifying the cause of lung infiltrates in children, especially those who are immunocompromised. Early OLB can lead to altered treatment strategies and improved outcomes in pediatric patients with respiratory failure.
Area of Science:
- Pediatric Pulmonology
- Diagnostic Procedures
- Immunocompromised Patients
Background:
- Lung infiltrates in children, particularly those who are immunocompromised, often present a diagnostic challenge.
- Accurate diagnosis is crucial for guiding appropriate treatment and improving patient outcomes.
- Open lung biopsy (OLB) is an invasive procedure, and its utility in pediatric cases requires careful consideration.
Purpose of the Study:
- To evaluate the diagnostic yield and clinical impact of open lung biopsy (OLB) in children with lung infiltrates of unknown etiology.
- To assess the safety and effectiveness of OLB in a cohort of critically ill pediatric patients.
Main Methods:
- Retrospective analysis of 19 open lung biopsies performed on 18 children over a 10-year period (1979-1989).
- Focus on patients with bilateral lung infiltrates and unknown etiology, including immunocompromised individuals.
- Assessment of diagnostic yield (histological and etiological) and impact on therapeutic strategy.
Main Results:
- High diagnostic yield: 95% for histological diagnosis and 74% for etiological diagnosis.
- Therapeutic strategies were altered in 14 of 18 patients based on biopsy findings.
- The procedure was well-tolerated with few complications and no procedure-related mortality, even in ventilated patients.
Conclusions:
- Open lung biopsy (OLB) is a safe and highly effective procedure for diagnosing the cause of lung infiltrates in pediatric patients.
- Early consideration of OLB is recommended for immunocompromised children with unexplained bilateral pulmonary infiltrates to facilitate timely diagnosis and treatment.
- The diagnostic and therapeutic benefits of OLB outweigh the risks in selected pediatric cases.
Abstract:
The role of open lung biopsy (OLB) in the diagnosis of the etiology of lung infiltrates in children was analyzed for a 10-year period 1979-1989 in a tertiary referral center. A total of 18 children had 19 lung biopsies to ascertain the cause of lung infiltrates. Thirteen of these children (72%) were immunocompromised due to treatment of hematological/solid malignancies and bone marrow transplantation. The clinical diagnosis was bilateral lung infiltrates of unknown etiology in 17 of 18 children. Eight of these children were ventilated for respiratory failure. The biopsy was useful in achieving a histological diagnosis in 18 of 19 samples (diagnostic yield 95%) and an etiological diagnosis in 14 of 19 samples (etiological yield 74%). Therapeutic strategy was altered in 14 of 18 patients based on the biopsy results. Five of 14 patients responded favorably to a change in specific treatment. The time interval from onset of respiratory illness to biopsy was 2-60 days (mean 16 days). Despite the critical state of these children there were few complications associated with the biopsy and no mortality directly related to the procedure. We recommend that OLB be undertaken sooner rather than later in immunocompromised children with bilateral pulmonary infiltrates of unknown etiology.