The Utility of Open Lung Biopsy in Patients With Diffuse Pulmonary Infiltrates as Related to Respiratory Distress,Its Impact on Decision Making by Urgent Intervention,and the Diagnostic Accuracy Based on the Biopsy Location

Abstract

Patients with diffuse pulmonary infiltrates (DPI), especially those who present with respiratory distress (RD), may benefit from early open lung biopsy (OLB) to guide management. Benefits of urgent OLB would be expected by saving the time to reach accurate specific diagnoses. The objectives of this study were (1) to evaluate the impact of OLB between patients presenting with and without RD, (2) to focus on the impact of an urgent OLB as compared to an elective OLB, and (3) to compare the different yields of specific diagnoses in the middle lobe or lingula as compared to the other lobes. Thirty-four patients (17 patients presented with RD and 17 patients did not) with an average age of 43 years who presented with DPI were selected to undergo an OLB. An urgent OLB was performed in 11unselected patients. Twelve specimens from the middle lobe or lingula were compared to 25 specimens from the other lobes. The impact of the OLB results on decision making did not differ significantly between patients with and without RD. Patients with RD suffered a higher in-hospital mortality rate, OLB-related complications, and longer mechanical ventilation requirements than the patients without RD. The impact on decision making and complications between urgent OLB and elective OLB was comparable. The diagnostic yield from biopsy sites in the middle lobe or lingula resembled those specimens from the other lobes. The authors conclude that OLB may play a role in decision making for patients with DPI. However, OLB makes no difference in decision making between patients with and without RD. Patients with RD undergoing OLB procedures may suffer a poorer outcome. Urgent OLB may not benefit patients with DPI in decision making. The biopsy site does not appear to affect the accuracy of the diagnostic yield from an OLB procedure.

Get full access to this article

View all access options for this article.

References

1. Cheson BD, Samlowski WE, Tang TT, Spruance SL. Value of open-lung biopsy in 87 immunocompromised patients with pulmonary infiltrates . Cancer. 1985;55: 453-459 .

2. Chuang MT, Raskin J, Krellenstein DJ, Teirstein AS. Bronchoscopy in diffuse lung disease: evaluation by open lung biopsy in nondiagnostic transbronchial lung biopsy . Ann Otol Rhinol Laryngol. 1987;96: 654-657 .

3. Burt ME, Flye MW, Webber BL, Wesley RA. Prospective evaluation of aspiration needle, cutting needle, transbronchial, and open lung biopsy in patients with pulmonary infiltrates . Ann Thorac Surg. 1981;32: 146-153 .

4. Leight GS Jr, Michaelis LL. Open lung biopsy for the diagnosis of acute, diffuse pulmonary infiltrates in the immunosuppressed patient . Chest. 1978;73: 477-482 .

5. Miller RR, Nelems B, Muller NL, Evans KG, Ostrow DN. Lingular and right middle lobe biopsy in the assessment of diffuse lung disease . Ann Thorac Surg. 1987;44: 269-273 .

6. Walker WA, Cole FH Jr, Khandekar A, Mahfood SS, Watson DC. Does open lung biopsy affect treatment in patients with diffuse pulmonary infiltrates? J Thorac Cardiovasc Surg. 1989;97: 534-540 .

7. Wagner JD, Stahler C, Knox S, Brinton M, Knecht B. Clinical utility of open lung biopsy for undiagnosed pulmonary infiltrates . Am J Surg. 1992;164: 104-107 ; discussion 108.

8. McCabe RE, Brooks RG, Catterall JR, Remington JS. Open lung biopsy in patients with non-Hodgkin’s lymphoma and pulmonary infiltrates . Chest. 1989;96: 319-324 .

9. Catterall JR, McCabe RE, Brooks RG, Remington JS. Open lung biopsy in patients with Hodgkin’s disease and pulmonary infiltrates . Am Rev Respir Dis. 1989;139: 1274-1279 .

10.

10. Miller R, Burton NA, Karwande SV, Jones KW, Doty DB, Gay WA Jr. Early, aggressive open lung biopsy in heart transplant recipients . J Heart Transplant. 1987;6: 96-99 .

11.

11. Lachapelle KJ, Morin JE. Benefit of open lung biopsy in patients with respiratory failure . Can J Surg. 1995;38: 316-321 .

12.

12. Gaussorgues P, Piperno D, Bachmann P, et al. Comparison of nonbronchoscopic bronchoalveolar lavage to open lung biopsy for the bacteriologic diagnosis of pulmonary infections in mechanically ventilated patients . Intensive Care Med. 1989;15: 94-98 .

13.

13. McKenna RJ Jr, Campbell A, McMurtrey MJ, Mountain CF. Diagnosis for interstitial lung disease in patients with acquired immunodeficiency syndrome (AIDS): a prospective comparison of bronchial washing, alveolar lavage, transbronchial lung biopsy, and open-lung biopsy . Ann Thorac Surg. 1986;41: 318-321 .

14.

14. Springmeyer SC, Hackman RC, Holle R, et al. Use of bronchoalveolar lavage to diagnose acute diffuse pneumonia in the immunocompromised host . J Infect Dis. 1986;154: 604-610 .

15.

15. Browne MJ, Potter D, Gress J, et al. A randomized trial of open lung biopsy versus empiric antimicrobial therapy in cancer patients with diffuse pulmonary infiltrates . J Clin Oncol. 1990;8: 222-229 .

16.

16. Bonfils-Roberts EA, Nickodem A, Nealon TF Jr. Retrospective analysis of the efficacy of open lung biopsy in acquired immunodeficiency syndrome . Ann Thorac Surg. 1990;49: 115-117 .

17.

17. Hall TS, Hutchins GM, Baker RR. A critical review of the use of open lung biopsy in the management of the oncologic patient with acute pulmonary infiltrates . Am J Clin Oncol. 1987;10: 249-252 .

18.

18. Potter D, Pass HI, Brower S, et al. Prospective randomized study of open lung biopsy versus empirical antibiotic therapy for acute pneumonitis in nonneutropenic cancer patients . Ann Thorac Surg. 1985;40: 422-428 .

19.

19. Gaensler EA, Carrington CB. Open biopsy for chronic diffuse infiltrative lung disease: clinical, roentgenographic, and physiological correlations in 502 patients . Ann Thorac Surg. 1980;30: 411-426 .

20.

20. Knudson RJ, Slatin RC, Lebowitz MD, Burrows B. The maximal expiratory flow-volume curve: normal standards, variability, and effects of age . Am Rev Respir Dis. 1976;113: 587-600 .

21.

21. Chechani V, Landreneau RJ, Shaikh SS. Open lung biopsy for diffuse infiltrative lung disease . Ann Thorac Surg. 1992;54: 296-300 .

22.

22. Papazian L, Thomas P, Bregeon F, et al. Open-lung biopsy in patients with acute respiratory distress syndrome . Anesthesiology. 1998;88: 935-944 .

23.

23. Warner DO, Warner MA, Divertie MB. Open lung biopsy in patients with diffuse pulmonary infiltrates and acute respiratory failure . Am Rev Respir Dis. 1988;137: 90-94 .

24.

24. Neuhaus SJ, Matar KS. The efficacy of open lung biopsy . Aust N Z J Surg. 1997;67: 181-184 .

25.

25. Bensard DD, McIntyre RC Jr, Waring BJ, Simon JS. Comparison of video thoracoscopic lung biopsy to open lung biopsy in the diagnosis of interstitial lung disease . Chest. 1993;103: 765-770 .

26.

26. Flabouris A, Myburgh J. The utility of open lung biopsy in patients requiring mechanical ventilation . Chest. 1999;115: 811-817 .

27.

27. Doolin EJ, Luck SR, Sherman JO, Raffensperger JG. Emergency lung biopsy: friend or foe of the immunosuppressed child? J Pediatr Surg. 1986;21: 485-487 .