Chest
The Benefits of Open Lung Biopsy in Patients with Previous Non-Diagnostic Transbronchial Lung Biopsy: A Guide to Appropriate Therapy
Section snippets
MATERIALS AND METHODS
In a 17-month period from May 1975 through September 1976, a total of 20 immunosuppressed adult patients underwent transbronchial lung biopsy for diagnostic evaluation of a pulmonary infiltrate. Thirteen critically ill patients with a nondiagnostic transbronchial lung biopsy who were unresponsive to empirical antibiotic treatment underwent open lung biopsy in an attempt to obtain a more specific diagnosis. Of these 13 patients, seven (53 percent) had an arterial oxygen pressure (PaO2) less than
RESULTS
Figure 1 shows the follow-up and final outcome of all 20 immunosuppressed patients undergoing a transbronchial lung biopsy. The underlying disease, radiologic findings, and pathologic diagnosis obtained from the 13 patients who underwent transbronchial biopsy with subsequent open lung biopsy is shown in Table 1. Open lung biopsy established a specific diagnosis in ten (77 percent) of the 13 patients who had a previous nondiagnostic transbronchial lung biopsy. In three patients, a nonspecific
DISCUSSION
Our experience indicates that when the transbronchial lung biopsy in immunosuppressed patients with malignant disease is nondiagnostic, an open lung biopsy should be performed if the clinical condition continues to deteriorate. A specific diagnosis, indicating a specific treatment, was obtained in 76 percent (10/13) of the patients. Appropriate aggressive chemotherapy or antibiotic therapy can be administered with salvage of 80 percent (8/10) of the patients. Greenman and associates7 have
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Manuscript received July 21, 1977; revision accepted July 3.
Co-directors, Chest Oncology Program