Chest
Volume 77, Issue 5, May 1980, Pages 647-650
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The Benefits of Open Lung Biopsy in Patients with Previous Non-Diagnostic Transbronchial Lung Biopsy: A Guide to Appropriate Therapy

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In a 17-month period, 20 immunosuppressed patients underwent transbronchial biopsy of the lung for diagnostic evaluation of a pulmonary infiltrate of unknown etiology. In 19 patients, the transbronchial biopsy was nondiagnostic Thirteen of the 19 patients were critically ill and were referred for an open lung biopsy. Eleven (85 percent) of these 13 patients left the hospital after open lung biopsy and appropriate medical treatment Two patients who were receiving mechanical ventilation at the time of open biopsy succumbed to the combination of their underlying disease and respiratory failure.

There were no deaths directly attributed to the open lung biopsy. Of the six patients whose condition appeared stable and who did not undergo open lung biopsy, two died from unrecognized progress of their underlying malignant disease. The remainder recovered. We conclude that open lung biopsy is safe in and beneficial to the diagnosis and subsequent treatment of unknown pulmonary infiltrates in immunosuppressed patients who previously had a nondiagnostic fiberoptic transbronchial biopsy of the lung.

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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

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