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Lung biopsy in the diagnosis and management of chILD
Gail H Deutsch1, Lisa R Young2
1Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle Children's Hospital, Department of Laboratories, Seattle, Washington, USA.
Insights
Surgical lung biopsy is a high-risk procedure for diagnosing interstitial and diffuse lung disease (chILD) in children. Proper handling and evaluation are crucial for accurate diagnosis and guiding treatment when other methods fail.
Area of Science:
- Pediatric Pulmonology
- Pathology
- Medical Diagnostics
Background:
- Children's interstitial and diffuse lung disease (chILD) encompasses diverse lung conditions in infants and children.
- Advancements in genetic and molecular diagnostics are altering the landscape of chILD diagnosis.
- Lung biopsy remains critical for critically ill children or when non-invasive methods are inconclusive.
Purpose of the Study:
- To provide an overview of optimal handling and evaluation of surgical lung biopsies for suspected chILD.
- To emphasize the role of pathology in integrated chILD diagnosis and management.
- To guide clinicians on maximizing diagnostic yield from lung biopsies.
Main Methods:
- Review of current literature and clinical practices for chILD diagnosis.
- Emphasis on multidisciplinary communication (clinician, radiologist, surgeon, pathologist).
- Discussion of optimal tissue sampling and utilization strategies.
Main Results:
- Surgical lung biopsy is an invasive but essential tool for specific chILD cases.
- Close collaboration is vital for determining optimal biopsy sites and tissue handling.
- Pathologic features are critical for diagnosing specific chILD entities and guiding therapy.
Conclusions:
- Optimal handling of surgical lung biopsies is essential for accurate chILD diagnosis.
- Pathology plays a pivotal role in integrating clinical, imaging, and laboratory findings.
- Multidisciplinary communication enhances diagnostic yield and patient management in chILD.
Abstract:
Children's interstitial and diffuse lung disease (chILD) comprises a large number of diverse entities ranging from disorders of lung development, maturation and function unique in infancy to immune-mediated, environmental, vascular and other conditions overlapping with adult disease. Pathologic evaluation of the lung has played a central role in characterizing many of these disorders, resulting in revised nomenclature and classifications to help guide clinical management(1-4). Technological advancements are rapidly uncovering genetic and molecular underpinnings of these conditions, as well as widening the phenotypes which bridge adult disease, often reducing the perceived need for diagnostic lung biopsy. As such the decision to get a lung biopsy in chILD is frequently for rapid ascertainment of disease in a critically ill child or when clinical presentation, imaging and laboratory studies fail to provide a cohesive diagnosis needed for treatment. While there have been modifications in surgical procedures for lung biopsy that minimize postoperative morbidity, it remains a high-risk invasive procedure, especially in a medically complex patient(5). Thus, it is essential that the lung biopsy be handled properly to maximize diagnostic yield, including close communication between the clinician, radiologist, surgeon, and pathologist before biopsy to determine best sampling site(s) and prioritization of tissue utilization. This review provides an overview of optimal handling and evaluation of a surgical lung biopsy for suspected chILD, with emphasis on specific conditions in which pathologic features play a critical role in providing an integrated diagnosis and guiding management.
