Introduction and Objectives Lung biopsy is frequently used in the management of children with chronic pulmonary disease to obtain a histological diagnosis. Previous studies have reported a high diagnostic yield and a low complication rate following lung biopsy in children. We set out to further evaluate the role of lung biopsy in this group of clinically challenging patients by reviewing our experience of this procedure.
Methods A retrospective case-note review was carried out of all patients under 18 yrs who underwent a lung biopsy from 1998 to 2011. Data collected included age, mode of biopsy, histological findings, pre and post biopsy diagnosis, pre and post biopsy treatment, and complications of the procedure.
Results Thirty three children (12 boys) underwent lung biopsy in the period studied. Their ages ranged from three months to 16 years (median 5 years 5 months). Five biopsies were obtained using a thoracoscopic approach, the remainder via thoracotomy. Following the procedure, 17 patients required ventilation on the intensive care unit for a median of two days. Eight children (24%) experienced a direct complication of the procedure. Seven required an intercostal drain for a pneumothorax, one a tension pneumothorax presenting six days post-operatively. The operative mortality was 12% (4/33). Three children (9%) died within 28 days of surgery, two due to progressive respiratory failure and one following pneumonia. One patient died three months post-operatively due to a persistent air leak from the biopsy site. Twenty-six (79%) biopsies provided a sample adequate for definitive histological diagnosis. In 16 (48%) children the working diagnosis and treatment was changed following lung biopsy.
Conclusion Lung biopsy retains a place in the management of children with chronic pulmonary disease when there is diagnostic doubt. However it carries a significant morbidity and mortality which must be borne in mind when considering the need for histological diagnosis.