Abstract
Background: LuTX is an accepted therapeutic option for a range of pulmonary conditions in which the diagnosis is often based on clinical data or on limited biopsy material. PostTX complications and recurrence of underlying disease may be related to the primary disease, and an accurate diagnosis is therefore essential.
Methods: A pathologic review was performed on 1056 primary LuTX over a period of 22 years (1998 to 2010). Diagnoses of native lungs were compared with referral diagnoses to assess the presence of discrepancies or expanded results (malignancies or infections).
Results: 73 (7%) cases presented a different or expanded diagnosis. Discrepancies were found in 34 of 1054 cases (3%). The highest percentage of discordance was depicted in COPD (12 of 344), with the final diagnosis of UIP (n=4), chronic interstitial fibrosis (n=4), silicosis (n=2), LAM (n=1) and sarcoidosis (n=1). 16 patients who were referred with the diagnosis of an interstitial lung disease had predominantly emphysema (n=12), bronchiectasis (n=2) and HX (n=2).
Expanded results included Aspergillus (n=11) and mycobacterial (n= 16) infections, carcinomas (n=10), cystic adenomatoid dysplasia (n=1) and carcinoid (n=1).
However, short- and long-term survival was not different in patients with different diagnoses, malignancies or implanted infections. Interestingly all mycobacterial infections and all malignancies occurred in patients with COPD
Conclusions: On account of this high rate of discrepancies and its possible influence on survival, frequently repeated clinicopathologic investigations should be performed during the waiting list period.
- © 2011 ERS
