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

Niloufar Hafezi1, Mark A Heimberger1, Kyle A Lewellen1

  • 1Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.

Pediatric Pulmonology
|February 11, 2020
PubMed
Summary
This summary is machine-generated.

Lung biopsy in pediatric interstitial lung disease (chILD) can guide diagnosis and influence steroid dosing, even when CT scans show no defined lesions. While overall medication use remained similar, pathology results informed management changes in over half of the patients studied.

Keywords:
biopsychILDchildrendiffuse lung diseaseinterstitial lung diseasepulmonary disease

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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.