Evaluation of outcome following open lung biopsy.
The utility of open lung biopsy in the management of patients with acute pulmonary infiltrates and/or progressive respiratory failure remains controversial, particularly in regard to its timing and impact on therapy. We reviewed our most recent 10-year experience with open lung biopsies in 73 patients and evaluated its effect on patient management and outcome. A total of 62 biopsies were done for progressive infiltrating disease, 53 with diffuse bilateral disease, and 9 with more focal infiltrates; 11 biopsies were done for nodular disease. Overall mortality was 25 per cent (18/73), all from the group with infiltrates; there were no deaths in patients with nodular disease (P = 0.034). No patients died who did not have acute respiratory failure (ARF) preoperatively, but mortality was 38 per cent (18/47) in those with ARF (P < 0.001). Immune system status and timing of the biopsy did not affect survival. Clinical management was changed in 40 patients based on biopsy results, but this did not affect survival, with a mortality rate of 20 per cent (8/40) in the group with changed management versus 30 per cent (10/33) for those with no changes (P = 0.457). In those patients with ARF, changes in management based on biopsy results occurred in 31 patients, eight of whom died (26 per cent); no changes in management were made in 16 patients, ten of whom died (62%, P = 0.033).(ABSTRACT TRUNCATED AT 250 WORDS)
Bove
P
P
William Beaumont Hospital, Royal Oak, Michigan.
Ranger
W
W
Pursel
S
S
Glover
J
J
Bove
K
K
Bendick
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D017563:Lung Diseases, Interstitial / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011658:Pulmonary Fibrosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate