Diagnosis of pneumonitis in immunocompromised patients by open lung biopsy

Haverkos, Harry W.; Dowling, John; William, Anderson; Myerowitz, Richard L.; Lerberg, David B.; Hakala, Thomas R.

doi:10.1002/1097-0142(19830915)52:6<1093::aid-cncr2820520627>3.0.co;2-4

Cited by 63 publications

(19 citation statements)

References 10 publications

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“…Open lung biopsy may identify only a nonspecific pathologic pattern of acute diffuse lung injury, interstitial fibrosis, or chronic pneumonia and not clarify the precipitating cause of the pulmonary process resulting in no change in therapy. Further, even if a specific diagnosis is found, some studies of open lung biopsies in immunocompromised patients have been unable to document that this leads to prolonged survival (5,8,(11)(12)(13). Finally, the results of prior studies on the yield of open lung biopsy may have only limited applicability to current patients because of the changing spectrum and frequency of pulmonary complications in immunocompromised hosts.…”

mentioning

confidence: 68%

“…Although these numbers are small, the low yield and high overall mortality has made us very wary about sending such patients to open lung biopsies. Others have also reported that neutropenic patients have a high likelihood of having nonspecific pathologic findings (6,11). Our study is not able to determine if those biopsied while on a ventilator might have had a better outcome with a biopsy if the procedure had been done earlier in their course.…”

Section: Discussionmentioning

confidence: 99%

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The Utility of Open Lung Biopsy in Patients with Hematologic Malignancies

White

Wong

Downey

2000

Am J Respir Crit Care Med

147

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The yield and impact of open lung biopsies in patients with hematologic malignancies and unexplained pulmonary processes were assessed and analyzed to determine factors that affected the yield. Records of 63 patients with hematologic malignancy, who underwent 67 open lung biopsies for diagnosis of an unknown pulmonary process from 1996 to 1998 at Memorial Sloan-Kettering Cancer Center, were retrospectively reviewed. A specific diagnosis was found in 41 (62%) of the biopsies. Changes in therapy were made in 37 (57%) of patients after biopsy results, but in 69% of those with a specific diagnosis. Survival at 30 and 90 d was increased in those with specific rather than a nonspecific pulmonary diagnosis. The factor most predictive of finding a specific diagnosis was the presence of a focal rather than a diffuse radiographic abnormality (79% versus 36%, p = 0.003). Neutropenic patients or those on mechanical ventilation had a low chance of finding a specific diagnosis. Having received pulmonary toxic chemotherapy in the 6 mo before the biopsy was associated with finding a nonspecific lung injury. Specific pulmonary diagnoses found were inflammatory diseases in 23% of cases, infections in 21%, and malignancy in 18%. Bronchiolitis obliterans with organizing pneumonia (BOOP) was the most common inflammatory disorder and fungi and bacteria were the most frequent infectious pathogens. Complications occurred in 13% of the biopsies, including five patients who required mechanical ventilation post-procedure; one death was associated with the biopsy. The risk was increased in those with less than 50,000 platelets. Complications were similar with video-assisted thoracoscopy (VATS) compared with thoracotomy. We conclude that open lung biopsy in patients with hematologic malignancy has a significant yield and impact on management of patients with hematologic malignancy.

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mentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

The Utility of Open Lung Biopsy in Patients with Hematologic Malignancies

White

Wong

Downey

2000

Am J Respir Crit Care Med

147

View full text Add to dashboard Cite

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“…Previous studies on the findings of SLB in immunocompromised patients showed that a specific diagnosis was obtained in 32-82% of patients [13,[20][21][22][23][24] and that the procedure led to a change in therapy in 28-69% [7,9,21,23]. A recent study by White et al of 67 immunocompromised patients with hematological malignancy including 25 post-HSCT patients found a specific diagnosis in 62% of cases, and overall changes in therapy based on the biopsy results were made in 57% of the cases.…”

Section: Discussionmentioning

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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“…Pneumothorax, hydropneumothorax, hemothorax, empyema, subcutaneous emphysema, wound hematoma, surgical site infection, bronchopleural fistula, and bacterial pneumonia are consistently reported. 21,102,107,[111][112][113][114] The most serious complications that can add considerable morbidity and mortality are empyema, bronchopleural fistula, and bleeding requiring reoperation. Table 1 shows the rates of these complications according to different authors.…”

Section: Tbb and Olbmentioning

confidence: 99%

Management of Pulmonary Infections in Kidney Transplant Patients

Camargo¹,

Gomes²,

Machado³

et al. 2003

Clinical Pulmonary Medicine

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Kidney transplantation is a cost-effective alternative for the treatment of end-stage renal disease, with clear survival and quality of life benefits. Infection is an important drawback in kidney transplantation and is second only to cardiovascular disease as a cause of death. Pulmonary infections occur in 8%-16% of all kidney transplant patients, with mortality ranging from 12%-16% in more recent studies. Bacteria as a group, Cytomegalovirus, Pneumocystis carinii, Legionella, and fungi, are the main agents. Although noninvasive methods are recommended for etiologic diagnosis, bronchoscopy or open lung biopsy is mandatory in the great majority of the cases. Both transbronchial biopsy and open lung biopsy provide more information about the etiologic agent compared with bronchoalveolar lavage alone, and open lung biopsy has a higher diagnostic yield, although it may be associated with more frequent and serious adverse events. Broad-spectrum empiric antimicrobial therapy should be instituted at the same time as an invasive diagnostic method is performed and treatment adjusted according to subsequent results. Empiric antimicrobial treatment and the invasive diagnostic method should be selected according to the severity of respiratory impairment, time of onset of disease after transplantation, the radiologic pattern, and specific epidemiological factors.

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Diagnosis of pneumonitis in immunocompromised patients by open lung biopsy

Cited by 63 publications

References 10 publications

The Utility of Open Lung Biopsy in Patients with Hematologic Malignancies

The Utility of Open Lung Biopsy in Patients with Hematologic Malignancies

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

Management of Pulmonary Infections in Kidney Transplant Patients

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