Original article: general thoracic
Open-lung biopsy guides therapy in children

https://doi.org/10.1016/S0003-4975(01)02516-4Get rights and content

Abstract

Background. Open-lung biopsy is uncommon in children. Modern indications and outcomes are unknown.

Methods. This is a retrospective review of 64 open-lung biopsies (58 patients) from 1976 to 1996. Open-lung biopsies were used to grade vasculopathy in 8 patients (12% of 64) with pulmonary hypertension and in 10 patients (16% of 64) with combined pulmonary hypertension and lung parenchymal disease. Forty-six biopsies (72%) were obtained to diagnose parenchymal disease. Comparisons were made between biopsies performed from 1976 to 1989 and from 1990 to 1996.

Results. In the period 1990 to 1996, there were significantly more infants (p = 0.03), comorbid disease (p = 0.009), extracorporeal membrane oxygenation support (p < 10−4), and ventilator dependence (p = 0.05) and significantly less immunocompromise (p = 0.04). A definitive diagnosis was made in 43 of 64 cases (67%) and altered workup in 63 of 64 cases (98%). No correlation existed between Heath-Edwards grade of microangiopathy and catheterization data. Definitive diagnosis was most strongly associated with a nonimmunocompromised patient (p < 10−4). Although only one death (1.5%) was related to open-lung biopsy, the procedure was associated with a 30% inhospital mortality rate and an 11% morbidity rate. Of the 19 deaths, 1 patient died from the procedure, 13 died from their diseases, and 5 had support withdrawn. Death was associated with preoperative ventilator dependence (p < 10−4) and extracorporeal membrane oxygenation (p = 0.007).

Conclusions. Pediatric open-lung biopsy commonly alters the diagnostic workup (98%). It is recommended for children who have been supported for 2 weeks by extracorporeal membrane oxygenation and for those with combined pulmonary hypertension and parenchymal lung disease. It is less useful in immunocompromised children.

Section snippets

Material and methods

We retrospectively reviewed 64 biopsies in 58 patients performed by a single surgeon from 1976 through the first 6 months of 1996 at the University of Minnesota Hospitals. Cases were identified by a private office file system checked against an independent computer search of ICD-9 codes by the hospital medical records department. Included in this study were all patients less than 21 years of age who underwent open-lung biopsy for diagnostic purposes. This includes both patients with congenital

Demographics

Sixty-four open-lung biopsies were performed on 58 patients between 1976 and 1996. Twenty-three of the patients (40%) were female and 35 were male. The ages of the patients ranged between 1 day and 21 years, median 3.7 years.

There were three main indications for open-lung biopsy in this group: 46 biopsies (72%) were to diagnose pulmonary parenchymal disease, 8 (12%) were to histologically grade the vasculopathy of pulmonary hypertension, and 10 (16%) were in patients with a combined clinical

Comment

Open-lung biopsy is an uncommon diagnostic procedure in the pediatric age group. Our goal was to quantify the anticipated risk and benefit of open-lung biopsy in subgroups of children by using our retrospective cohort. The specific risk of death within 30 days and the specific benefit of a definitive diagnosis were analyzed as a function of clinical variables in order to advise future patients and their families considering this operation. These data are now available in Table 2, Table 3. Using

Acknowledgements

The authors thank Cathy Marquardt for her assistance in the accumulation of medical records. Also, we thank Douglas Baldwin, MD, and Mary Macauley for their assistance in the preparation of the manuscript and scientific presentation.

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