title: Bronchoalveolar lavage and lung biopsy in patients with cancer and hematopoietic stem-cell transplantation recipients: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The objective of this study was to describe the diagnostic yield and complication rate of bronchoalveolar lavage (BAL) and lung biopsy in the evaluation of pulmonary lesions in patients with cancer and recipients of hematopoietic stem-cell transplantation (HSCT).
  
  
  METHODS
  We conducted a systematic literature review and performed electronic searches of Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. Studies were included if patients had cancer or were recipients of HSCT, and if they underwent BAL or lung biopsy for the evaluation of pulmonary lesions. Only English language publications were included.
  
  
  RESULTS
  In all, 14,148 studies were screened; 72 studies of BAL and 31 of lung biopsy were included. The proportion of procedures leading to any diagnosis was similar by procedure type (0.53 v 0.54; P = .94) but an infectious diagnosis was more common with BAL compared with lung biopsy (0.49 v 0.34; P < .001). Lung biopsy more commonly led to a noninfectious diagnosis (0.43 v 0.07; P < .001) and was more likely to change how the patient was managed (0.48 v 0.31; P = .002) compared with BAL. However, complications were more common with lung biopsy (0.15 v 0.08; P = .006), and procedure-related mortality was four-fold higher for lung biopsy (0.0078) compared with BAL (0.0018).
  
  
  CONCLUSIONS
  BAL may be the preferred diagnostic modality for the evaluation of potentially infectious pulmonary lesions because of lower complication and mortality rates; thus, choice of procedure depends on clinical suspicion of infection. Guidelines to promote consistency in the approach to the evaluation of lung infiltrates may improve clinical care of patients.
authors.affiliation: DeepakBabu Chellapandian, Joseph Beyene, and Lillian Sung, The Hospital for Sick Children, Toronto; Joseph Beyene, McMaster University, Hamilton, Ontario, Canada; Thomas Lehrnbecher, Johann Wolfgang Goethe University, Frankfurt, Germany; Bob Phillips, Centre for Reviews and Dissemination, University of York, York, United Kingdom; Brian T. Fisher and Theoklis E. Zaoutis, Children's Hospital of Philadelphia, Philadelphia, PA; and William J. Steinbach, Duke University Medical Center, Durham, NC.
authors.forename: DeepakBabu
authors.initials: D
authors.lastname: Chellapandian
authors.affiliation: DeepakBabu Chellapandian, Joseph Beyene, and Lillian Sung, The Hospital for Sick Children, Toronto; Joseph Beyene, McMaster University, Hamilton, Ontario, Canada; Thomas Lehrnbecher, Johann Wolfgang Goethe University, Frankfurt, Germany; Bob Phillips, Centre for Reviews and Dissemination, University of York, York, United Kingdom; Brian T. Fisher and Theoklis E. Zaoutis, Children's Hospital of Philadelphia, Philadelphia, PA; and William J. Steinbach, Duke University Medical Center, Durham, NC.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lehrnbecher
authors.affiliation: DeepakBabu Chellapandian, Joseph Beyene, and Lillian Sung, The Hospital for Sick Children, Toronto; Joseph Beyene, McMaster University, Hamilton, Ontario, Canada; Thomas Lehrnbecher, Johann Wolfgang Goethe University, Frankfurt, Germany; Bob Phillips, Centre for Reviews and Dissemination, University of York, York, United Kingdom; Brian T. Fisher and Theoklis E. Zaoutis, Children's Hospital of Philadelphia, Philadelphia, PA; and William J. Steinbach, Duke University Medical Center, Durham, NC.
authors.forename: Bob
authors.initials: B
authors.lastname: Phillips
authors.affiliation: DeepakBabu Chellapandian, Joseph Beyene, and Lillian Sung, The Hospital for Sick Children, Toronto; Joseph Beyene, McMaster University, Hamilton, Ontario, Canada; Thomas Lehrnbecher, Johann Wolfgang Goethe University, Frankfurt, Germany; Bob Phillips, Centre for Reviews and Dissemination, University of York, York, United Kingdom; Brian T. Fisher and Theoklis E. Zaoutis, Children's Hospital of Philadelphia, Philadelphia, PA; and William J. Steinbach, Duke University Medical Center, Durham, NC.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Fisher
authors.affiliation: DeepakBabu Chellapandian, Joseph Beyene, and Lillian Sung, The Hospital for Sick Children, Toronto; Joseph Beyene, McMaster University, Hamilton, Ontario, Canada; Thomas Lehrnbecher, Johann Wolfgang Goethe University, Frankfurt, Germany; Bob Phillips, Centre for Reviews and Dissemination, University of York, York, United Kingdom; Brian T. Fisher and Theoklis E. Zaoutis, Children's Hospital of Philadelphia, Philadelphia, PA; and William J. Steinbach, Duke University Medical Center, Durham, NC.
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
authors.affiliation: DeepakBabu Chellapandian, Joseph Beyene, and Lillian Sung, The Hospital for Sick Children, Toronto; Joseph Beyene, McMaster University, Hamilton, Ontario, Canada; Thomas Lehrnbecher, Johann Wolfgang Goethe University, Frankfurt, Germany; Bob Phillips, Centre for Reviews and Dissemination, University of York, York, United Kingdom; Brian T. Fisher and Theoklis E. Zaoutis, Children's Hospital of Philadelphia, Philadelphia, PA; and William J. Steinbach, Duke University Medical Center, Durham, NC.
authors.forename: William J
authors.initials: WJ
authors.lastname: Steinbach
authors.affiliation: DeepakBabu Chellapandian, Joseph Beyene, and Lillian Sung, The Hospital for Sick Children, Toronto; Joseph Beyene, McMaster University, Hamilton, Ontario, Canada; Thomas Lehrnbecher, Johann Wolfgang Goethe University, Frankfurt, Germany; Bob Phillips, Centre for Reviews and Dissemination, University of York, York, United Kingdom; Brian T. Fisher and Theoklis E. Zaoutis, Children's Hospital of Philadelphia, Philadelphia, PA; and William J. Steinbach, Duke University Medical Center, Durham, NC.
authors.forename: Joseph
authors.initials: J
authors.lastname: Beyene
authors.affiliation: DeepakBabu Chellapandian, Joseph Beyene, and Lillian Sung, The Hospital for Sick Children, Toronto; Joseph Beyene, McMaster University, Hamilton, Ontario, Canada; Thomas Lehrnbecher, Johann Wolfgang Goethe University, Frankfurt, Germany; Bob Phillips, Centre for Reviews and Dissemination, University of York, York, United Kingdom; Brian T. Fisher and Theoklis E. Zaoutis, Children's Hospital of Philadelphia, Philadelphia, PA; and William J. Steinbach, Duke University Medical Center, Durham, NC. lillian.sung@sickkids.ca.
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
mesh_terms: D000328:Adult; D001230:Aspergillus / Q000235:genetics / Q000302:isolation & purification*; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy / Q000009:adverse effects / Q000401:mortality; D018893:Bronchoalveolar Lavage / Q000009:adverse effects; D005690:Galactose / Q000031:analogs & derivatives; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis; D008351:Mannans / Q000032:analysis; D009369:Neoplasms / Q000601:surgery*; D011014:Pneumonia / Q000175:diagnosis / Q000382:microbiology; D016133:Polymerase Chain Reaction; D055732:Pulmonary Aspergillosis / Q000175:diagnosis
chemical_list: D015415:Biomarkers; D008351:Mannans; C012990:galactomannan; D005690:Galactose