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Lung biopsy for chronic pulmonary disease in children
Robert M Greenhalgh1, Iain E Yardley1, Fran Child2
1Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.
Insights
Pediatric lung biopsy aids in diagnosing chronic pulmonary disease but carries significant risks. This study found that while 79% of biopsies provided a diagnosis, the procedure had a 12% operative mortality rate.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Histopathology
Background:
- Lung biopsy is a critical diagnostic tool for pediatric chronic pulmonary disease.
- Evaluating the risks and benefits of lung biopsy in children is essential for clinical decision-making.
Purpose of the Study:
- To assess the diagnostic yield and complication rates of lung biopsy in pediatric patients with chronic pulmonary disease.
- To review the clinical impact of lung biopsy findings on patient management.
Main Methods:
- Retrospective case-note review of pediatric patients (<16 years) undergoing lung biopsy between 1998 and 2011.
- Analysis of procedural complications, operative mortality, and diagnostic outcomes.
Main Results:
- Thirty-three children underwent lung biopsy; 79% yielded a definitive histological diagnosis.
- Complication rate was 30%, including pneumothorax and pneumonia. Operative mortality was 12%.
- In 48% of cases, biopsy findings led to changes in diagnosis and treatment.
Conclusions:
- Lung biopsy is valuable for diagnosing pediatric chronic pulmonary disease, significantly influencing management.
- The procedure is associated with substantial risks, including mortality, necessitating careful consideration of its use.
Introduction And Objectives:
Lung biopsy is frequently used in the management of children with chronic pulmonary disease to obtain a histological diagnosis. We further evaluate the role of lung biopsy by reviewing our experience of this procedure.
Methods:
A retrospective case-note review was carried out of all patients in our regional service under 16 years who underwent a lung biopsy from 1998 to 2011.
Results:
Thirty-three children (12 boys) (median 5 years 5 months, range 2 months to 16 years) underwent lung biopsy in the period studied. Following the procedure, 17 patients required ventilation on the intensive care unit for a median of two days (range 1-56 days). Complication rate was 30% (10/33); seven simple pneumothoraces, one tension pneumothorax, and one pneumonia (one child experienced more than one complication). The operative mortality was 12% (4/33). Three children (9%) died within 28 days of surgery. Twenty-six (79%) biopsies provided a definitive histological diagnosis. In 16 (48%) children, the working diagnosis and treatment were changed following lung biopsy.
Conclusion:
Lung biopsy has an important role in the management of children with chronic pulmonary disease. However, it carries significant risks which must be considered when assessing the need for histological diagnosis.
