Impact of open lung biopsy for undiagnosed pulmonary infiltrates in patients with hematological malignancies

Abstract

Pulmonary complications are frequently encountered in patients with hematological malignancy. The optimal therapeutic decision including open lung biopsy (OLB) for such patients is uncertain. We herein examine the clinical impact of OLB on these patients. Seven patients with progressively diffuse pulmonary infiltrates despite aggressive medical treatment were examined. The underlying diseases, prior treatment for presumptive pneumonia, the change in therapeutic approach after operation, and clinical outcome were reviewed retrospectively. Diffuse pulmonary infiltrates were caused by infection in two patients and by noninfectious etiology such as alveolar proteinosis, idiopathic interstitial pneumonitis, leukemic involvement, and drug-induced alveolar damage in the others. Four patients who had serious underlying hematologic diseases such as myelodysplastic syndrome, acute and chronic myeloid leukemia, and T cell lymphoma died. Three patients with acute lymphoid leukemia survived. In two of these three, change of therapeutic strategies after OLB was created for the survival. OLB in patients with hematological malignancy may be useful in selected patients with a treatable hematologic disease who have treatable underlying causes of the pulmonary infiltrate. Am. J. Hematol. 68:87-90, 2001.

CT‐guided percutaneous lung biopsies in patients with haematologic malignancies and undiagnosed pulmonary lesions

“…Although we could not find any previous study describing how percutaneous lung biopsy results affect the therapeutic decisions in immunocompromised patients with pulmonary lesions, studies dealing with the use of OLB in this clinical setting have shown conflicting results [5][6][7][8][9]13,14,22]. In the current study, a change in treatment based on biopsy results occurred in 61% of patients and was more likely to occur in patients with a specific biopsy diagnosis than in those without.…”

“…Use of small-caliber chest tubes attached to a Heimlich valve allows outpatient management of postbiopsy pneumothoraces (with successful removal of the chest tubes the day after the biopsy procedure in most patients) [40]. Respiratory failure necessitating prolonged postoperative mechanical ventilation, which has been reported as a complication after OLB, was not encountered in any of our patients [5][6][7][8][9]13,14,22].…”

“…These changes can be secondary to a variety of conditions that include bronchiolitis obliterans, drug toxicity, vasculitis, alveolar hemorrhage or interstitial fibrosis [5][6][7][8][9]13,14,22]. Needle biopsies in patients with these conditions yield inflammatory cells and fibrosis, which are generally categorized as nonspecific.…”

“…TBB can help improve the diagnostic yield [10,21]; in a study by Cazzadori et al [21] TBB had a higher diagnostic yield than BAL. Although OLB has been shown to be superior to other procedures in terms of yielding a specific diagnosis, OLB is an invasive procedure and can be associated with significant morbidity and even mortality [5][6][7][8][9]13,14,22]. Compared with bronchoscopic procedures, needle biopsy avoids contamination of the specimen.…”

Pulmonary alveolar proteinosis

“…Pulmonary infection with Nocardia, Pneumocystis, Acinetobacter, Aspergillus, Cladosporium, or Mycobacerium tuberculosis or non-tuberculosis mycobacteria have been associated with PAP [56,61]. Positive PAS staining of intra-and extracellular material is sufficient for the diagnosis of PAP and may negate a lung biopsy or autopsy [54,62]. Indeed, in numerous case reports a diagnosis of PAP is obtained only by autopsy [57].…”