Do Immunocompromised Children Benefit from Having Surgical Lung Biopsy Performed?

Abstract

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 werebeneficialfor 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

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

“…White et al [11] demonstrated that surgical lung biopsy yield was decreased among neutropenic patients who recently received pulmonary toxic chemotherapy and were on mechanical ventilation at the time of biopsy. Similarly, other groups have previously demonstrated that among immunocompromised children following stem cell transplant, surgical lung biopsy rarely redirected therapy and did not improve outcomes [12,13]. These data highlight the need for careful consideration of the risks and benefits of surgical lung biopsy among these acutely ill patients.…”

Thoracoscopic lung biopsy in diagnosis of malignancy in children

“…It is also used in therapy of metastases in sarcomatous lesions, such as osteosarcoma, soft tissue sarcoma and chondrosarcoma, as well as non-sarcomatous lesions such as colorectal cancer, hepatocellular carcinoma, breast cancer, renal cell carcinoma, squamous cell gynaecological cancer, adenoid cystic cancer, biliary cancer and germ cell tumor [4,5]. Lung biopsy is a valuable diagnostic method in diagnosis of nonmalignant diseases, including infectious [1,[6][7][8] and non-infectious [9][10][11][12] complications after stem cell transplantation .…”

Therapeutic Impact and Complications Associated with Surgical Lung Biopsy after Allogeneic Hematopoietic Stem Cell Transplantation in Children

“…Surgical lung biopsy (SLB) is often considered in an attempt to secure a definitive diagnosis and guide therapeutic decisionmaking. SLB is uniquely valuable in that it provides tissue for histopathologic interrogation even though the reported diagnostic yield is variable, ranging from 37% to 97% [12,[15][16][17]. The impact of SLB on the management of HSCT recipients with pulmonary complications is not clear because subsequent changes in therapy are reported to occur in 40% to 90% of patients [17][18][19][20][21].…”