Role of flexible bronchoscopy in the diagnosis of pulmonary infiltrates in pediatric patients with cancer.
We reviewed 60 consecutive flexible bronchoscopies done during a 36-month period in 48 pediatric cancer patients with undiagnosed pulmonary infiltrates. Diagnostic procedures during bronchoscopy included 40 brushings, 50 bronchoalveolar lavages, and 6 transbronchial and mucosal biopsies. A total of 16 specific diagnoses were made by bronchoscopy (27% diagnostic yield), including infection (12), pulmonary leukemia (3), and lymphoma (1). The largest proportion of specific diagnoses came from lavage (14/50) and the smallest from brushings (1/40). Biopsies were also useful for selected patients. The low overall yield for bronchoscopy was probably due to the routine use of empiric broad-spectrum antibiotics and antifungal therapy, as well as trimethoprim-sulfamethoxazole prophylaxis for Pneumocystis carinii pneumonitis. Subsequent specific diagnoses were obtained by other procedures (open biopsy, needle aspiration, or autopsy) for 10 patients with negative bronchoscopy results and 3 patients with diagnostic bronchoscopies. These additional diagnoses included 7 infections (Pneumocystis carinii (1), Candida tropicalis (1), cytomegalovirus (1), and Aspergillus (4), and 6 other diagnoses with nonspecific histologic findings. A positive bronchoscopy result may be useful, but negative bronchoscopy findings do not justify delaying other diagnostic procedures or discontinuing antibiotic and antifungal therapy in children with cancer and pulmonary infiltrates.
Stokes
D C
DC
Cardiopulmonary-Critical Care Division, St. Jude Children's Research Hospital, Memphis, TN 38101-0318.
Shenep
J L
JL
Parham
D
D
Bozeman
P M
PM
Marienchek
W
W
Mackert
P W
PW
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000209:etiology; D009369:Neoplasms / Q000150:complications*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis; D007507:Therapeutic Irrigation
D000900:Anti-Bacterial Agents; D000666:Amphotericin B