Open Lung Biopsy: A Safe, Reliable and Accurate Method for Diagnosis in Diffuse Lung Disease

Shah, Samir S.; Tsang, Victor; Goldstraw, Peter

doi:10.1159/000196066

Cited by 43 publications

(17 citation statements)

References 22 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…13,16,[23][24][25] We found a negative influence of diffuse alveolar damage and respiratory failure, mainly for men and with underlying disease (P > 0.05). It is widely known that the presence of underlying disease has a deleterious influence on the outcome of a pneumopathy and that diffuse alveolar damage is related to critical clinical pictures.…”

Section: Discussionmentioning

confidence: 77%

Semiquantitative Assessment of Surgical Lung Biopsy: Predictive Value and Impact on Survival of Patients With Diffuse Pulmonary Infiltrate

Canzian

Soeiro

Taga

et al. 2007

Clinics

View full text Add to dashboard Cite

. Semiquantitative assessment of surgical lung biopsy: predictive value and impact on survival of patients with diffuse pulmonary infiltrate. Clinics. 2007; 62(1):23-30.PURPOSE: Surgical lung biopsy has been studied in distinct populations, mostly going beyond clinical issues to impinge upon routine histopathological diagnostic information in diffuse infiltrates; however, detailed tissue analyses have rarely been performed. The present study was designed to investigate the prognostic contribution provided by detailed tissue analysis in diffuse infiltrates. METHODS: Medical records and surgical lung biopsies from the period of 1982 to 2003 of 63 patients older than 18 years with diffuse infiltrates were retrospectively examined. Lung parenchyma was histologically divided into 4 anatomical compartments: interstitium, airways, vessels, and alveolar spaces. Histological changes throughout these anatomical compartments were then evaluated according to their acute or chronic evolutional character. A semiquantitative scoring system was applied to histologic findings to evaluate the intensity and extent of the pathological process. We applied logistic regression to predict the risk of death associated with acute and chronic histological changes and to estimate the odds ratios for each of the independent variables in the model. RESULTS: Impact on survival was found for male gender (P = 0.03), presence of diffuse alveolar damage (P = 0.001), and chronic histological changes (P = 0.0004) on biopsy. Thus, being male was associated with a slightly lower risk (O.R. = 0.18; P=0.03) of dying than being female. Death risk was increased 17 times in the presence of acute histological changes such as diffuse alveolar damage and 2.5 times in the presence of chronic histological changes. CONCLUSION: Detailed analysis of histological specimens can provide more than a nosological diagnosis: this approach can provide valuable information concerning prognosis.

show abstract

Section: Discussionmentioning

confidence: 77%

Semiquantitative Assessment of Surgical Lung Biopsy: Predictive Value and Impact on Survival of Patients With Diffuse Pulmonary Infiltrate

Canzian

Soeiro

Taga

et al. 2007

Clinics

View full text Add to dashboard Cite

show abstract

“…Whether the procedure alters the clinical management represents an important outcome. Several retrospective studies addressing these issues in series of patients with a variety of diffuse parenchymal diseases are available (74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85). In selected reports, the results have been very heterogeneous: the diagnostic yield ranged from 34% to 100%; therapy was altered in 46% to 75% of the cases.…”

Section: Transbronchial Biopsy Haematoxylin-eosin-stained Transbroncmentioning

confidence: 99%

Hypersensitivity pneumonitis

Girard

and

Cormier

2009

Allergy

114

View full text Add to dashboard Cite

The first few cases of hypersensitivity pneumonitis (HP) were described in the early 20th century in farmers exposed to moldy hay or straw. As then, HP has been ascribed to multiple inhaled antigens found in a large variety of environmental settings. Hypersensitivity pneumonitis results from an exaggerated immune response, which gives rise to acute infection‐like symptoms or to progressive, sometimes irreversible lung damage. The diagnosis is based on a combination of clinical characteristics of the disease. Clinical diagnostic criteria have recently been published. The immune mechanisms leading to HP are still incompletely understood. Initially, believed to be a classes III and IV immune response, we now have a clearer understanding of the complex inflammatory events involved. These include the release of pro inflammatory cytokines and a decrease in the immune control mechanisms via surfactant, dendritic and T‐regulatory cells. Despite the improved understanding, the treatment and outcome of HP have not changed. Oral corticosteroids remain the only effective drugs and contact withdrawal constitutes the ideal solution. If unchecked, HP can lead to irreversible lung damage in the form of fibrosis or emphysema, respiratory insufficiency and even death.

show abstract

“…In this situation, lung tissue histologic examination may be useful, particularly in immunocompromised patients as suggested from older series [8,9]. Hence, surgical biopsy is a recognized accurate diagnostic method for diffuse lung disease in immunocompetent patients [10]. In patients with respiratory distress, many authors suggest that surgical open lung biopsies (OLBs) can be performed safely with a high diagnosis yield [11,12], even if the they have hematologic diseases [13].…”

Section: Introductionmentioning

confidence: 99%

Impact of bedside open lung biopsies on the management of mechanically ventilated immunocompromised patients with acute respiratory distress syndrome of unknown etiology

Charbonney

Robert

Pache

et al. 2009

Journal of Critical Care

View full text Add to dashboard Cite

Background: Open lung biopsy (OLB) is helpful in the management of patients with acute respiratory distress syndrome (ARDS) of unknown etiology. We determine the impact of surgical lung biopsies performed at the bedside on the management of patients with ARDS. Methods: We reviewed all consecutive cases of patients with ARDS who underwent a surgical OLB at the bedside in a medical intensive care unit between 1993 and 2005. Results: Biopsies were performed in 19 patients mechanically ventilated for ARDS of unknown etiology despite extensive diagnostic process and empirical therapeutic trials. Among them, 17 (89%) were immunocompromised and 10 patients experienced hematological malignancies. Surgical biopsies were obtained after a median (25%-75%) mechanical ventilation of 5 (2-11) days; mean (±SD) PaO 2 / FiO 2 ratio was 119.3 (±34.2) mm Hg. Histologic diagnoses were obtained in all cases and were specific in 13 patients (68%), including 9 (47%) not previously suspected. Immediate complications (26%) were local (pneumothorax, minimal bleeding) without general or respiratory consequences. The biopsy resulted in major changes in management in 17 patients (89%). It contributed to a decision to limit care in 12 of 17 patients who died. Conclusion: Our data confirm that surgical OLB may have an important impact on the management of patients with ARDS of unknown etiology after extensive diagnostic process. The procedure can be performed at the bedside, is safe, and has a high diagnostic yield leading to major changes in management, including withdrawal of vital support, in the majority of patients.

show abstract

Open Lung Biopsy: A Safe, Reliable and Accurate Method for Diagnosis in Diffuse Lung Disease

Cited by 43 publications

References 22 publications

Semiquantitative Assessment of Surgical Lung Biopsy: Predictive Value and Impact on Survival of Patients With Diffuse Pulmonary Infiltrate

Semiquantitative Assessment of Surgical Lung Biopsy: Predictive Value and Impact on Survival of Patients With Diffuse Pulmonary Infiltrate

Hypersensitivity pneumonitis

Impact of bedside open lung biopsies on the management of mechanically ventilated immunocompromised patients with acute respiratory distress syndrome of unknown etiology

Contact Info

Product

Resources

About