The usefulness of open-lung biopsy in the pediatric bone marrow transplant population

Shorter, Nicholas A.; Ross, Arthur J.; August, Charles S.; Schnaufer, Louise; Zeigler, Moritz; Templeton, John Y.; Bishop, Harry A.; O’Neill, James A.

doi:10.1016/s0022-3468(88)80363-4

Cited by 40 publications

(21 citation statements)

References 36 publications

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“…Unless a treatable cause is found for the lung disease, the mortality in such patients is high. Recent studies have questioned the value of open lung biopsy in this group of patients citing the argument that a high diagnostic yield does not necessarily alter the overall prognosis of the patient significantly [25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

“…The mortality associated with this group of patients in all forms of lung biopsy is well documented and can be as high as 62% [26,[29][30][31][32]. Thus, in patients whose lung function is so severely im paired as to necessitate mechanical ventilation either preor post-operatively, or requiring high-dose corticosteroid therapy, open lung biopsy should be considered as a highrisk procedure.…”

Section: Discussionmentioning

confidence: 99%

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

Shah

Tsang²,

Goldstraw³

1992

Respiration

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The ideal method for obtaining lung tissue for diagnosis should provide high diagnostic yield with low morbidity and mortality. We reviewed all 432 patients (mean age 55 years) who underwent an open lung biopsy at this hospital over a 10-year period. Twenty-four patients (5.5%) were immunocompromised. One hundred and twenty-five patients were on steroid therapy at the time of operation. Open lung biopsy provided a firm diagnosis in 410 cases overall (94.9%) and in 20 out of 24 patients in the immunocompromised group (83.3%). The commonest diagnosis was cryptogenic fibrosing alveolitis (173 patients). Twenty-two patients (5.1%) suffered complications following the procedure: wound infection 11 patients, pneumothorax 9 patients and haemothorax 1 patient. Thirteen patients (3.0%) died following open lung biopsy, but in only 1 patient was the death attributable to the procedure itself. We conclude that open lung biopsy is an accurate and safe method for establishing a diagnosis in diffuse lung disease with a high yield and minimal risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Shah

Tsang²,

Goldstraw³

1992

Respiration

View full text Add to dashboard Cite

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“…The patients were considered neutropenic when their ANC was less than 500 cells/mm 3 . Change in therapy was defined as addition or withdrawal of therapy including antimicrobials, chemotherapy, corticosteroids, or diuretics.…”

Section: Methodsmentioning

confidence: 99%

“…Pulmonary infiltrates of uncertain etiology in immunocompromised patients present a diagnostic and therapeutic challenge [1][2][3]. The differential diagnosis of such infiltrates includes a wide range of infectious and noninfectious conditions [4,5].…”

Section: Introductionmentioning

confidence: 99%

Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: Improved Outcome with specific diagnosis

et al. 2005

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Using a retrospective review of medical records, we sought the findings of surgical lung biopsy (SLB) in patients with hematological malignancy or hematopoietic stem cell transplantation (HSCT) and unexplained pulmonary infiltrates and to determine the impact of this procedure on management and outcome of these patients. Sixty-two patients who underwent SLB were evaluated; 31 patients had underlying hematological malignancy and 31 patients were HSCT recipients; 58% of whom underwent allogeneic HSCT. Thirty-three patients (53%) had focal infiltrates on chest CT scan while 29 (47%) had diffuse infiltrates. Thirteen patients were mechanically ventilated prior to SLB, and 27 (43%) were neutropenic. There were 66 diagnoses in the 62 patients, 44 (67%) were specific and 22 (33%) were nonspecific. The most common specific diagnoses were infection (29%), malignancy (27%), and inflammatory conditions (11%). Aspergillosis was the most common diagnosis of all biopsies (21%). SLB led to a change in therapy in 40% of patients and was associated with complications in 7 patients (11%). Specific diagnosis was more likely to lead to a change in therapy (48% vs. 27%, P = 0.06) and was associated with a lower mortality when compared to a nonspecific finding (30% vs. 59%, P = 0.02). Nonspecific diagnosis, on the other hand, was seen more in patients on mechanical ventilation prior to SLB compared to those off mechanical ventilation (69% vs. 27%, P = 0.02). SLB provides a specific diagnosis in the majority of patients with hematologic malignancy or HSCT recipients and unexplained pulmonary infiltrates. Specific diagnosis is more likely to lead to a change in therapy and is associated with a better outcome. Am. J. Hematol. 78:94-99, 2005. ª 2005 Wiley-Liss, Inc.

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“…Noninfectious diseases are a relatively uncommon cause of pulmonary infiltrates in immunocompromised children, but have been documented by open lung biopsy (OLB) or autopsy [48,52,104,108,109]. Their true frequency is unknown.…”

Section: Other Conditionsmentioning

confidence: 99%

Bronchoalveolar lavage in children. ERS Task Force on bronchoalveolar lavage in children. European Respiratory Society

Blic¹,

Midulla²,

Barbato³

et al. 2000

Eur Respir J

352

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Bronchoalveolar lavage (BAL) is routinely performed in adults for sampling cellular and biochemical components. Many studies have been performed that have enabled the proposal of recommendations for BAL, methodology and processing, as well as reference values in different clinical settings. In contrast, despite a world-wide increase in the use of BAL in children, including neonates, there are, at the present time, no clear recommendations on the methodology, the clinical applications and the research areas for BAL. A Task Force on BAL in children has been approved by the European Respiratory Society (ERS) Task Force committee 1996. The objectives of this task force were: 1) to provide recommendations and guidelines on how to perform BAL and how to process the return fluid in children; 2) to collect and discuss available reference values; 3) to list indications and results in both immunocompetent and immunocompromised children; 4) to define areas for future research.This task force included paediatric respiratory physicians involved in bronchoscopy and BAL and was run as a collaboration between the Paediatric Bronchology Group and the BAL scientific group of the ERS.

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The usefulness of open-lung biopsy in the pediatric bone marrow transplant population

Cited by 40 publications

References 36 publications

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

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

Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: Improved Outcome with specific diagnosis

Bronchoalveolar lavage in children. ERS Task Force on bronchoalveolar lavage in children. European Respiratory Society

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