Lung biopsy in immunocompromised hosts

Greenman, Richard L.; Goodall, Patrick T.; King, Donald P.

doi:10.1016/0002-9343(76)90345-4

Cited by 9 publications

(14 citation statements)

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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: 96%

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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Section: Discussionmentioning

confidence: 96%

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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“…In this situation, lung tissue histologic examination may be useful, particularly in immunocompromised patients as suggested from older series [8,9]. Hence, surgical biopsy is a recognized accurate diagnostic method for diffuse lung disease in immunocompetent patients [10].…”

Section: Introductionmentioning

confidence: 99%

Impact of bedside open lung biopsies on the management of mechanically ventilated immunocompromised patients with acute respiratory distress syndrome of unknown etiology

Charbonney

Robert

Pache

et al. 2009

Journal of Critical Care

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Background: Open lung biopsy (OLB) is helpful in the management of patients with acute respiratory distress syndrome (ARDS) of unknown etiology. We determine the impact of surgical lung biopsies performed at the bedside on the management of patients with ARDS. Methods: We reviewed all consecutive cases of patients with ARDS who underwent a surgical OLB at the bedside in a medical intensive care unit between 1993 and 2005. Results: Biopsies were performed in 19 patients mechanically ventilated for ARDS of unknown etiology despite extensive diagnostic process and empirical therapeutic trials. Among them, 17 (89%) were immunocompromised and 10 patients experienced hematological malignancies. Surgical biopsies were obtained after a median (25%-75%) mechanical ventilation of 5 (2-11) days; mean (±SD) PaO 2 / FiO 2 ratio was 119.3 (±34.2) mm Hg. Histologic diagnoses were obtained in all cases and were specific in 13 patients (68%), including 9 (47%) not previously suspected. Immediate complications (26%) were local (pneumothorax, minimal bleeding) without general or respiratory consequences. The biopsy resulted in major changes in management in 17 patients (89%). It contributed to a decision to limit care in 12 of 17 patients who died. Conclusion: Our data confirm that surgical OLB may have an important impact on the management of patients with ARDS of unknown etiology after extensive diagnostic process. The procedure can be performed at the bedside, is safe, and has a high diagnostic yield leading to major changes in management, including withdrawal of vital support, in the majority of patients.

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“…11,12,[23][24][25][26][27] Autopsy results in 18 (72%) patients verified the accuracy of SLB in all but 7 cases; the additional diagnosis (4 infectious pneumonias, 5 diffuse alveolar damages, and 1 bronchiolitis) may represent infections or complications resulting from them, which occurred between SLB and death. In many patients, the preoperative diagnosis was either erroneous or incomplete.…”

Section: Discussionmentioning

confidence: 68%

“…[3][4][5][6][7] In contrast, reported mortality rates for all patients (hypoxic and nonhypoxic) undergoing SLB tend to be lower. 4,[8][9][10] Greenman and coworkers 11 found a 73% mortality rate in hypoxic (PaO 2 < 55 mm Hg) immunosuppressed patients and a 39% mortality rate in nonhypoxic patients. In immunosuppressed patients, Jaffe and Maki 12 found a significantly higher PaO 2 in survivors of SLB, as compared to nonsurvivors.…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Surgical Lung Biopsy and Autopsy Findings and Clinical Data in Patients With Diffuse Pulmonary Infiltrates and Acute Respiratory Failure

Canzian

Soeiro

Taga

et al. 2006

Clinics

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Lung biopsy in immunocompromised hosts

Cited by 9 publications

References 0 publications

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

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

Impact of bedside open lung biopsies on the management of mechanically ventilated immunocompromised patients with acute respiratory distress syndrome of unknown etiology

Correlation Between Surgical Lung Biopsy and Autopsy Findings and Clinical Data in Patients With Diffuse Pulmonary Infiltrates and Acute Respiratory Failure

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