title: Factors that increase diagnostic yield of surgical lung biopsy in pediatric oncology patients.
abstract: OBJECTIVE
  Recent data demonstrate that surgical lung biopsy in immunocompromised children, including oncology patients, alters therapy in only 50% of cases. We hypothesized that there are factors identifiable preoperatively which can predict the patients who will or will not benefit from surgical biopsy.
  
  
  METHODS
  We reviewed the medical records of all children with malignancy who underwent surgical lung biopsy between 2004 and 2013 at a single institution, excluding those children who had previously undergone a solid organ or bone marrow transplant.
  
  
  RESULTS
  Eighty lung wedge biopsies were performed (median age 13 years, IQR 5.25-16; 63% male, n=50) 53 (66%) of which led to a change in patient management. The majority of biopsies were performed to diagnose a new mass or differentiate infection from metastases (mass group) (n=68, 85%), and 12 biopsies (15%) were performed to diagnose a known infection for antibiotic guidance (infection group). Children in the infection group were more likely to be febrile preoperatively, were more likely to be an inpatient preoperatively, and had a lower absolute neutrophil count at the time of biopsy. Patients in the infection group had higher postoperative mortality rates and higher rates of major complications.
  
  
  CONCLUSIONS
  In pediatric oncology patients, surgical lung biopsy has a lower diagnostic yield and higher complication rate when performed for antibiotic guidance. Prior to proceeding with biopsy in this high-risk patient population, surgeons and oncologists should carefully weigh the potential risks and benefits.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: Shannon.acker@ucdenver.edu.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Acker
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: Danielle.gonzales@ucdenver.edu.
authors.forename: Danielle
authors.initials: D
authors.lastname: Gonzales
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: james.ross@ucsfmedctr.org.
authors.forename: James T
authors.initials: JT
authors.lastname: Ross
authors.affiliation: Department of Pediatric Pathology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: megan.dishop@childrenscolorado.org.
authors.forename: Megan K
authors.initials: MK
authors.lastname: Dishop
authors.affiliation: Department of Pediatric Pulmonology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: robin.deterding@childrenscolorado.org.
authors.forename: Robin R
authors.initials: RR
authors.lastname: Deterding
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: david.partrick@childrenscolorado.org.
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
mesh_terms: D001706:Biopsy / Q000379:methods*; D002648:Child; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008168:Lung / Q000473:pathology*; D008297:Male; D009369:Neoplasms / Q000473:pathology* / Q000601:surgery; D013510:Pulmonary Surgical Procedures; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Antibiotic guidance; Lung biopsy; Pediatric oncology