Open Lung Biopsy Provides a Higher and More Specific Diagnostic Yield Compared to Broncho-Alveolar Lavage in Immunocompromised Patients

Abstract

In order to examine the feasibility and safety of undertaking a larger prospective study to compare the diagnostic yield from concurrent open lung biopsy (OLB) and bronchoalveolar lavage (BAL) in febrile neutropenic patients with pulmonary infiltrates and the impact of such knowledge on clinical outcome, a pilot exploratory study was performed. 13 immunocompromised patients (mainly with haematological malignancy or bone marrow transplantation recipients) were investigated. At least one diagnostic finding in 12 of 13 patients was provided by OLB compared to 4 of 13 patients by BAL. BAL provided 7 specific diagnoses (pneumocystis 1, fungal infection 3, bacterial pneumonia 1, pulmonary haemorrhage 2) whilst OLB provided 12 specific diagnosis (CMV 2, pneumocystis 3, fungal infection 1, bacterial pneumonia 1, pulmonary haemorrhage 4, pulmonary embolism 1). Five patients with nonspecific interstitial/alveolar inflammation were diagnosed only by OLB. The concordance that the exact same specific diagnoses present in the OLB were found in the BAL was zero. There were 2 minor complications (1 wound infection by OLB, 1 moderate haemorrhage by BAL). Mortality at 28 days was 8 of 13 patients which in no case was related to either procedure. We suggest that OLB is a safe procedure in such patients, provides superior and more complete diagnostic information compared to BAL and a larger controlled study to investigate the impact of early OLB on the outcome of these patients appears to be justified.

Pulmonary cytolytic thrombi: a newly recognized complication of stem cell transplantation

“…This is likely due to the peripheral location and intravascular nature of the nodules. Open-lung biopsy has been reported to have increased diagnostic sensitivity for infectious and non-infectious diagnoses over bronchoalveolar lavage in immunocompromised patients 29 and this was confirmed in our experience in this group of patients.…”

Radiologically guided fine needle lung biopsies in the evaluation of focal pulmonary lesions in allogeneic stem cell transplant recipients

“…7,8,20 However, OLB is an invasive procedure and is associated with significant morbidity and even mortality. Therefore, radiologically guided FNLB might be preferred in some patients with focal pulmonary lesions after SCT.…”

“…Open lung biopsy (OLB) [6][7][8] is an invasive procedure with potential complications. Although radiologically guided fine needle lung biopsy (FNLB) has been commonly used in other patient groups, [9][10][11] this method has rarely been applied in allogeneic SCT recipients.…”

Analysis of chemokines and soluble adhesion molecules in cytomegalovirus-positive renal transplant recipients

“…The published data about the prevalence of CMV infection in Saudi transplant recipients is scanty [13,14]. Aljurf et al [13] determined CMV infection in 641 Saudi allogeneic bone marrow transplantation patients.…”

“…Only two patients had CMV infection. Ellis et al [14] described CMV infection in 2 out of 13 immunocompomised patients following open lung biopsy.…”