Lung biopsy in children's interstitial and diffuse lung disease: Does it alter management?

Area of Science:

• Pediatric Pulmonology
• Thoracic Pathology
• Medical Diagnostics

Background:

• Children's interstitial and diffuse lung disease (chILD) often requires empiric treatment with corticosteroids, immune modulators, and antibiotics.
• Diagnosis can be challenging, as histological evaluation via lung biopsy may not always yield a definitive diagnosis or alter clinical management.
• Computed tomography (CT) imaging may not reveal defined lesions in some chILD cases.

Purpose of the Study:

• To investigate whether lung biopsy in pediatric patients with chILD, particularly those without defined CT lesions, guides diagnosis and alters clinical management.
• To assess the impact of lung biopsy on steroid dosing, immune modulator use, antibiotic therapy, and oxygen support.

Main Methods:

• Retrospective review of pediatric patients who underwent lung biopsy between 2013 and 2018.
• Inclusion criteria: patients without defined lesions on CT imaging.
• Analysis of demographic data, length of stay, oxygen requirements, and medication use (steroids, immune modulators, antibiotics) pre- and post-biopsy.

Main Results:

• Nineteen of 64 (30%) patients without defined CT lesions were included in the study.
• A significant difference was observed in prednisone dosing at 2 weeks and 2 months post-biopsy compared to pre-biopsy levels (P=.03).
• Pathology results provided diagnostic information in 12 of 19 (63%) patients, leading to management changes, although overall antibiotic and immune modulator use did not significantly differ.

Conclusions:

• Lung biopsy can guide clinical management in chILD, notably impacting steroid dosing strategies.
• Despite no significant aggregate changes in antibiotic or immune modulator use, pathological findings from biopsies offer crucial diagnostic information.
• Biopsy results led to therapeutic management modifications in over half of the pediatric patients studied, underscoring its value in complex chILD cases.