J. Sobrino1, N. Le1, J. Sujka1, L. A. Benedict1, R. M. Rentea1, H. Alemayehu1, T. A. Oyetunji1, S. D. St.Peter1 1Children’s Mercy Hospital- University Of Missouri Kansas City,Surgery,Kansas City, MO, USA
Introduction:
The indications for lung biopsy cover a wide array of pulmonary disease. While the morbidity of the procedure has decreased with the use of thoracoscopy, lung biopsy still holds substantial risk for the patients as they all have some degree of pulmonary dysfunction. Therefore we evaluated the likelihood of lung biopsies impacting treatment compared to complications.
Methods:
This is an IRB approved, single-institution, retrospective chart review of all patients less than 18 years of age undergoing lung biopsy as the primary operation between January 2010 and August 2016. Demographics were recorded, as well as details of patient presentation, pre-operative and post-operative management, operative course, peri-operative vital signs, pathology, adverse events, complications, and follow-up. Complications were defined as being related directly to the technical aspects of the lung biopsy, while adverse events were defined as clinical deterioration attributable to the overall process of lung biopsy and underlying lung disease. All values are reported as medians with interquartile range (IQR).
Results:
38 patients met criteria for inclusion in the study during the time period evaluated. The median age was 6.9 years old (IQR 1.5, 14.6 years) with a median weight of 18 kg (10.4, 52 kg). The median length of operation was 41.5 minutes (IQR 29.8, 55.5 minutes). The median length of follow up was 1.9 years (IQR 1.0, 3.5 years).[TO1] 87% (33) of biopsies were performed thoracoscopically, with a 3% conversion rate to thoracotomy.
Adverse events occurred in 21% (n=8) of cases including prolonged respiratory failure (18%, n=7) and cancellation of a planned joint procedure [TO2] due to acute respiratory failure (3%, n=1). Complications occurred in 16% (6) of cases including pneumothorax (13%, n=5) and cardiac arrest (3%, n=1). A third of these complications (33%, n=2) required re-operation, and both were urgent decompressions of tension pneumothoraces. There was a 10% (n=4) mortality rate during the same hospitalization.
The majority (68%, n=26) of cases were referred for lung biopsy with a working diagnosis of interstitial or diffuse lung disease. The pathology was definitive in 63% (n=24) of cases, yet it only changed the diagnosis in less than a third (29%). Treatment was changed 42% of cases, and in 5% of cases, a negative biopsy dictated subsequent management. There was no statistically significant difference between cases where pathology changed treatment in terms of age, weight, operative time, and length of follow-up.
Conclusion:
Lung biopsy for questionable pulmonary disease changed treatment in less than half of cases, with significant perioperative morbidity. Careful consideration should therefore be given to who would benefit most from lung biopsy.