Open-lung biopsy in patients with undiagnosed lung lesions referred at a tertiary cancer center is safe and reveals noncancerous, noninfectious entities as the most common diagnoses

Abstract

We evaluated the diagnostic yield of open-lung biopsies (OLBs) in a large tertiary cancer center to determine the role of infectious diseases as causes of undiagnosed pulmonary lesions. All consecutive adult patients with either single or multiple pulmonary nodules or masses who underwent a diagnostic OLB over a period of 10 years (1998–2007) were retrospectively identified. Their risk factors for malignancy and clinical and radiological characteristics were reviewed, and their postoperative complications were assessed. We evaluated 155 patients with a median age of 57 years (range, 19–83 years). We identified infectious etiologies in 29 patients (19 %). The most common diagnosis in this group was histoplasmosis (12 [41 %]), followed by nontuberculous mycobacterial infection (7 [24 %]) and aspergillosis (4 [14 %]). The majority of the 126 remaining patients had nonmalignant diagnoses, the most prevalent being nonspecific granuloma (26 %), whereas only 17 % had malignant diagnoses. We observed no significant differences among the patients with infectious, malignant, or both noninfectious and nonmalignant final diagnoses regarding their demographic, laboratory, and clinical characteristics. Six percent of the patients had at least one post-OLB complication, and the post-OLB mortality rate was 1 %. OLB is a safe diagnostic procedure which frequently identifies a wide variety of infectious and inflammatory diseases.

Clinical and radiographic differentiation of lung nodules caused by mycobacteria and lung cancer: a case–control study

“…Mycobacteria are common causative organisms of lung nodules as reflected by previous reports that describe infection as a common etiology (~20 %) of suspicious lung nodules, with around 25 % of such infections corresponding to mycobacteria [ 22 ]. Additionally, an increase in the incidence and prevalence of mycobacterial infections in different areas of the world has been described [ 23 – 25 ]; likely due to increased awareness of their role as human pathogens [ 24 ]; and possibly due to environmental and pathogen-specific factors [ 26 ].…”

The diagnostic yield and complications of open lung biopsies in kidney transplant patients with pulmonary disease

“…CMV, cytomegalovirus. practice the number of patients submitted to flexible bronchoscopy prior OLB may be less than expected (43)(44)(45)(46). Some of the potential explanations include lesions localization, conditions that could increase the risk of complications such as high levels of positive end-expiratory pressure, risk of bleeding, and pulmonary hypertension, and the general believe in the low diagnostic yield of the procedure (43).…”

Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients (allogeneic SCT excluded): updated guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

“…OLB is a relatively safe procedure with a complication rate of ∼6% [ 51 ], including the risk of hemorrhage [ 49 , 52 ] even in thrombocytopenic patients [ 51 , 53 ]. Histologically, no infection or malignancy, but nonspecific inflammation is detected in the majority of patients [ 31 , 51 , 53 ]. Notably, findings from OLB and BAL obtained simultaneously may show different microbiological results [ 31 ].…”