Do Immunocompromised Children Benefit from Having Surgical Lung Biopsy Performed?

2014 ◽  
Vol 133 (2) ◽  
pp. 205-209 ◽  
Author(s):  
Gal Goldstein ◽  
Nathan Keller ◽  
Ron Bilik ◽  
Bella Bielorai ◽  
Amos Toren
Keyword(s):  
Lung Biopsy ◽  
Diagnostic Yield ◽  
Hematologic Malignancy ◽  
Major Complication ◽  
Surgical Lung Biopsy ◽  
Diagnostic Biopsy ◽  
Preoperative Factor ◽  
Lung Biopsies ◽  
Clinical Records ◽  
The Impact

Background: Surgical lung biopsy is considered a gold standard for the evaluation of pulmonary disease in immunocompromised children. However, in the literature, its accuracy and the rate of complications vary. Objective: We aimed to evaluate the yield of surgical lung biopsies in the management of persistent pulmonary findings in immunocompromised children. Methods: We performed a retrospective review of clinical records of immunocompromised children who underwent surgical lung biopsies, and evaluated the impact that preoperative factors had on outcomes. Results: Twenty-five patients underwent 27 surgical lung biopsies. The underlying immunodeficiency included allogeneic stem cell transplantation (n = 12), chemotherapy for solid tumors (n = 6), hematologic malignancy (n = 4), primary immunodeficiency (n = 4) and chronic steroid use (n = 1). Biopsies provided a specific histopathologic or microbiologic diagnosis in 10 cases (37%). No preoperative factor predicted a diagnostic biopsy. Five of the 27 biopsies were beneficial for the patients (18%). A major complication related to the procedure was reported for 1 biopsy (4%). Conclusions: We conclude that surgical lung biopsy in pediatric immunocompromised patients appears to be safe, but has a relatively low diagnostic yield and an even lower yield with regards to the benefit it provides. © 2014 S. Karger AG, Basel

Impact of Lung Biopsy on Lung Function in Idiopathic Pulmonary Fibrosis

Respiration ◽  
2020 ◽  
pp. 1-8
Author(s):  
Pierre-Henri Aussedat ◽  
Nader Chebib ◽  
Kais Ahmad ◽  
Jean-Charles Glerant ◽  
Gabrielle Drevet ◽  
...  
Keyword(s):  
Lung Function ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Forced Vital Capacity ◽  
Lung Biopsy ◽  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Surgical Lung Biopsy ◽  
Before And After ◽  
The Impact

<b><i>Background:</i></b> Video-assisted surgical lung biopsy (SLB) is performed in 10–30% of cases to establish the diagnosis of idiopathic pulmonary fibrosis (IPF). <b><i>Objectives:</i></b> The aim of the study was to analyze the impact of SLB on lung function in patients eventually diagnosed with IPF. <b><i>Methods:</i></b> This is an observational, retrospective, monocentric study of all consecutive patients eventually diagnosed with IPF in multidisciplinary discussion who underwent SLB over 10 years in a specialized center. The primary end point was the variation in forced vital capacity (FVC) before and after the SLB. The secondary end points were the variations in forced expiratory volume in one second (FEV1), total lung capacity (TLC), carbon monoxide diffusion capacity (DLCO), and morbidity and mortality associated with the SLB. <b><i>Results:</i></b> In 118 patients who underwent SLB and were diagnosed with IPF, a relative decrease in FVC of 4.8% (<i>p</i> &#x3c; 0.001) was found between measurements performed before and after the procedure. The mean FVC decrease was 156 ± 386 mL in an average period of 185 days, representing an annualized decline of 363 ± 764 mL/year. A significant decrease was also observed after SLB in FEV1, TLC, and DLCO. Complications within 30 days of SLB occurred in 14.4% of patients. Two patients (1.7%) died within 30 days, where one of them had poor lung function. Survival at 1 year was significantly poorer in patients with FVC &#x3c;50% at baseline. <b><i>Conclusion:</i></b> In this uncontrolled study in patients ultimately diagnosed with IPF, SLB was followed by a significant decline in FVC, which appears to be numerically greater than the average decline in the absence of treatment in the literature. <b><i>Summary at a Glance:</i></b> This study evaluated the change in lung function in 118 consecutive patients diagnosed with idiopathic pulmonary fibrosis by surgical lung biopsy. Forced vital capacity decreased by 156 ± 386 mL in a mean of 185 days between the last measurement before and first measurement after biopsy, representing an annualized decline of 363 ± 764 mL/year.

scholarly journals Diagnostic yield of CT-guided lung biopsies: how can we limit negative sampling?

2021 ◽  
Author(s):  
Marcello Andrea Tipaldi ◽  
Edoardo Ronconi ◽  
Miltiadis E Krokidis ◽  
Aleksejs Zolovkins ◽  
Gianluigi Orgera ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Lung Biopsy ◽  
Diagnostic Yield ◽  
Imaging Features ◽  
Technical Success ◽  
Ct Guided ◽  
Fdg Uptake ◽  
Increased Risk ◽  
Ct Guided Biopsy ◽  
Lung Biopsies

Objectives: To investigate whether lesion imaging features may condition the outcome of CT-guided Lung Biopsy (CTLB) and to develop a scoring system of biopsy outcome prediction. Methods: This is a single center retrospective study on 319 CTLBs that were performed in 319 patients (167 males/ 152 females, mean age 68 ± 12.2). Uni- and multivariate analysis were performed aiming to assess the imaging features that are likely to be corelated to a negative biopsy outcome and patients were stratified in groups accordingly. Results: Technical success was 100%. 78% of the biopsies (250/319) led to a concrete histology report (218 malignant/ 32 benign). The remaining lesions led to concrete histology at a second attempt that occurred on a later time. Multivariate analysis revealed increased risk of inconclusive result for nodules with low FDG uptake (OR = 2.64, 95% CI 1.4–4.97; p = 0.003), for nodules with diameter smaller than 18 mm (OR = 2.03, 95% CI 1.14–3.62; p = 0.017) and for nodules that are located in one of the lung bases (OR = 1.96, 95% CI 1.06–3.62; p = 0.033). Three different groups of patients were identified accordingly with low (<30%), medium (30–50%) and high (>50%) probability of obtaining an inconclusive biopsy sample. Conclusions: This study confirms that percutaneous CT guided biopsy in nodules that are either small in diameter or present low PET-FDG uptake or are in one of the lung bases may lead to inconclusive histology. This information should be factored when planning percutaneous biopsies of such nodules in terms of patient informed consent and biopsy strategy. Advances in knowledge: Inconclusive histology after lung biopsy may be subject to factors irrelevant to technical success. Lung biopsy histology outcomes may be predicted and avoided after adequate planning

scholarly journals Video-Assisted Thoracoscopic Lung Biopsy in Critically Ill Patients With Hematologic Malignancy and Acute Respiratory Distress Syndrome: A Case Series Report

2020 ◽  
Vol 8 ◽  
pp. 232470962091210
Author(s):  
Elizabeth Arrieta ◽  
Saveria Sangiovanni ◽  
Juan Esteban Garcia-Robledo ◽  
Mauricio Velásquez ◽  
Luz Fernanda Sua ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
High Risk ◽  
Respiratory Distress Syndrome ◽  
Critically Ill ◽  
Lung Biopsy ◽  
Distress Syndrome ◽  
Diagnostic Yield ◽  
Diffuse Alveolar Damage ◽  
Hematologic Malignancy ◽  
Hematologic Malignancies

Pulmonary complications are prevalent among patients with hematologic malignancies, who are at high risk of developing acute respiratory distress syndrome (ARDS). Although diffuse alveolar damage is considered the diagnostic hallmark of ARDS, there are plenty of other non–diffuse alveolar damage etiologies that can mimic ARDS and benefit from a specific therapy, therefore correcting the underlying cause. When the etiology remains unclarified despite noninvasive procedures, a surgical lung biopsy (either open via thoracotomy or video-assisted thoracoscopic surgery [VATS]) may be warranted. However, the role of surgical lung biopsy has not been extensively studied in patients with hematologic malignancy and ARDS and so doubt exists about the risk-benefit relationship of such procedures. In this article, we report a series of 8 critically ill patients with hematologic malignancies and ARDS, who underwent VATS lung biopsy, in a specialized institution in Cali, Colombia, from 2015 to 2019, with special emphasis on its diagnostic yield, modifications in treatment protocol, and safety. VATS lung biopsy is a minimally invasive procedure that appears to be a relatively safe with few postoperative complications and minimal perioperative mortality. It has a high diagnostic yield, resulting in a modification of treatment in a nondepreciable percentage of patients. However, this subset of patients was critically ill, with a high risk of mortality, and the lung biopsy did not appear to affect in this aspect. Future randomized controlled trials are needed to further clarify this topic.

scholarly journals Optimization of the Lung Biopsy Procedure: A Primer

2021 ◽  
Author(s):  
Dayananda Lingegowda ◽  
Bharat Gupta ◽  
Anisha Gehani ◽  
Saugata Sen ◽  
Priya Ghosh
Keyword(s):  
Patient Safety ◽  
Practice Guidelines ◽  
Diagnostic Tool ◽  
Complication Rate ◽  
Lung Biopsy ◽  
Diagnostic Yield ◽  
High Diagnostic Yield ◽  
Image Guided ◽  
Management Of Complications ◽  
Lung Biopsies

AbstractImage-guided lung biopsy plays a very important role in the diagnosis and management of lung lesions. As a diagnostic tool, it demands a high diagnostic yield and a low complication rate. It is imperative to balance the diagnostic yield and patient safety during lung biopsies. The aim of this article is to review the standard practice guidelines of lung biopsy, to describe the techniques used to minimize the complications associated with lung biopsy, and to describe the management of complications.

Factors that increase diagnostic yield of surgical lung biopsy in pediatric oncology patients

2015 ◽  
Vol 50 (9) ◽  
pp. 1490-1492 ◽  
Author(s):  
Shannon N. Acker ◽  
Danielle Gonzales ◽  
James T. Ross ◽  
Megan K. Dishop ◽  
Robin R. Deterding ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Lung Biopsy ◽  
Diagnostic Yield ◽  
Oncology Patients ◽  
Surgical Lung Biopsy

scholarly journals Surgical lung biopsy for the diagnosis of interstitial lung disease in England: 1997–2008

2016 ◽  
Vol 48 (5) ◽  
pp. 1453-1461 ◽  
Author(s):  
John P. Hutchinson ◽  
Tricia M. McKeever ◽  
Andrew W. Fogarty ◽  
Vidya Navaratnam ◽  
Richard B. Hubbard
Keyword(s):  
Lung Cancer ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Lung Biopsy ◽  
International Classification Of Diseases ◽  
Surgical Lung Biopsy ◽  
Using Data ◽  
Lung Biopsies ◽  
The Uk

International guidelines and new targeted therapies for idiopathic pulmonary fibrosis have increased the need for accurate diagnosis of interstitial lung disease (ILD), which may lead to more surgical lung biopsies. This study aimed to assess the risk of this procedure in patients from the UK.We used Hospital Episodes Statistics data from 1997 to 2008 to assess the frequency of surgical lung biopsy for ILD in England, UK. We identified cardiothoracic surgical patients using International Classification of Diseases revision 10 codes for ILD and Office of Population Censuses and Surveys Classification of Interventions and Procedures version 4 codes for surgical lung biopsy. We excluded those with lung resections or lung cancer. We estimated in-hospital, 30-day and 90-day mortality following the procedure, and linked to cause of death using data from the UK Office of National Statistics.We identified 2820 patients with ILD undergoing surgical lung biopsy during the 12-year period. The number of biopsies increased over the time period studied. In-hospital, 30-day and 90-day mortality were 1.7%, 2.4% and 3.9%, respectively. Male sex, increasing age, increasing comorbidity and open surgery were risk factors for mortality.Surgical lung biopsy for ILD has a similar mortality to lobectomy for lung cancer, and clinicians and patients should understand the likely risks involved.

Transbronchial cryobiopsy increases diagnostic confidence in interstitial lung disease: a prospective multicentre trial

2020 ◽  
Vol 56 (6) ◽  
pp. 1901520
Author(s):  
Jürgen Hetzel ◽  
Athol U. Wells ◽  
Ulrich Costabel ◽  
Thomas V. Colby ◽  
Simon L.F. Walsh ◽  
...  
Keyword(s):  
Lung Biopsy ◽  
International Study ◽  
Sampling Technique ◽  
Diagnostic Algorithm ◽  
Severe Bleeding ◽  
Diagnostic Confidence ◽  
Critical Determinant ◽  
Surgical Lung Biopsy ◽  
First Choice ◽  
The Impact

IntroductionThe accurate diagnosis of individual interstitial lung diseases (ILD) is often challenging, but is a critical determinant of appropriate management. If a diagnosis cannot be made after multidisciplinary team discussion (MDTD), surgical lung biopsy is the current recommended tissue sampling technique according to the most recent guidelines. Transbronchial lung cryobiopsy (TBLC) has been proposed as an alternative to surgical lung biopsy.MethodsThis prospective, multicentre, international study analysed the impact of TBLC on the diagnostic assessment of 128 patients with suspected idiopathic interstitial pneumonia by a central MDTD board (two clinicians, two radiologists, two pathologists). The level of confidence for the first-choice diagnoses were evaluated in four steps, as follows: 1) clinicoradiological data alone; 2) addition of bronchoalveolar lavage (BAL) findings; 3) addition of TBLC interpretation; and 4) surgical lung biopsy findings (if available). We evaluated the contribution of TBLC to the formulation of a confident first-choice MDTD diagnosis.ResultsTBLC led to a significant increase in the percentage of cases with confident diagnoses or provisional diagnoses with high confidence (likelihood ≥70%) from 60.2% to 81.2%. In 32 out of 52 patients nondiagnostic after BAL, TBLC provided a diagnosis with a likelihood ≥70%. The percentage of confident diagnoses (likelihood ≥90%) increased from 22.7% after BAL to 53.9% after TBLC. Pneumothoraces occurred in 16.4% of patients, and moderate or severe bleeding in 15.7% of patients. No deaths were observed within 30 days.InterpretationTBLC increases diagnostic confidence in the majority of ILD patients with an uncertain noninvasive diagnosis, with manageable side-effects. These data support the integration of TBLC into the diagnostic algorithm for ILD.

Fibrosis pulmonar idiopática: Impacto de la biopsia de pulmón en la función pulmonar

2021 ◽  
Vol 3 (1) ◽  
pp. 18-19
Author(s):  
Ricardo Lemus-Rangel
Keyword(s):  
Lung Function ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Forced Vital Capacity ◽  
Lung Biopsy ◽  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Surgical Lung Biopsy ◽  
Before And After ◽  
The Impact

<b>Background:</b> Video-assisted surgical lung biopsy (SLB) is performed in 10–30% of cases to establish the diagnosis of idiopathic pulmonary fibrosis (IPF). <b>Objectives:</b> The aim of the study was to analyze the impact of SLB on lung function in patients eventually diagnosed with IPF. <b>Methods:</b> This is an observational, retrospective, monocentric study of all consecutive patients eventually diagnosed with IPF in multidisciplinary discussion who underwent SLB over 10 years in a specialized center. The primary end point was the variation in forced vital capacity (FVC) before and after the SLB. The secondary end points were the variations in forced expiratory volume in one second (FEV<sub>1</sub>), total lung capacity (TLC), carbon monoxide diffusion capacity (DLCO), and morbidity and mortality associated with the SLB. <b>Results:</b> In 118 patients who underwent SLB and were diagnosed with IPF, a relative decrease in FVC of 4.8% (<i>p</i> &#x3c; 0.001) was found between measurements performed before and after the procedure. The mean FVC decrease was 156 ± 386 mL in an average period of 185 days, representing an annualized decline of 363 ± 764 mL/year. A significant decrease was also observed after SLB in FEV<sub>1</sub>, TLC, and DLCO. Complications within 30 days of SLB occurred in 14.4% of patients. Two patients (1.7%) died within 30 days, where one of them had poor lung function. Survival at 1 year was significantly poorer in patients with FVC &#x3c;50% at baseline. <b>Conclusion:</b> In this uncontrolled study in patients ultimately diagnosed with IPF, SLB was followed by a significant decline in FVC, which appears to be numerically greater than the average decline in the absence of treatment in the literature. Summary at a Glance: This study evaluated the change in lung function in 118 consecutive patients diagnosed with idiopathic pulmonary fibrosis by surgical lung biopsy. Forced vital capacity decreased by 156 ± 386 mL in a mean of 185 days between the last measurement before and first measurement after biopsy, representing an annualized decline of 363 ± 764 mL/year.

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