I. J. Zamora1, S. C. Fallon1, T. J. Vece2, J. Rama2, D. L. Palazzi2, J. A. Coss Bu2, M. Hicks3, M. E. Lopez1, J. G. Nuchtern1,2, M. DeGuzman2, R. P. Guillerman4, F. Sheikh1, P. Lau1, D. L. Cass1,2 1Texas Children’s Hospital, Baylor College Of Medicine,Michael E. DeBakey Department Of Surgery,Houston, TX, USA 2Texas Children’s Hospital, Baylor College Of Medicine,Department Of Pediatrics,Houston, TX, USA 3Texas Children’s Hospital, Baylor College Of Medicine,Department Of Pathology,Houston, TX, USA 4Texas Children’s Hospital, Baylor College Of Medicine,Department Of Radiology,Houston, TX, USA
Introduction:
Pediatric surgeons are consulted for parenchymal lung biopsy in complicated patients with respiratory and immunologic illnesses, and occasionally compromised healing abilities. Biopsy poses risks, and results may be non-diagnostic. The purpose of this study was to assess the risk-to-benefit ratio of lung biopsy by determining the operative complications and impact on clinical management.
Methods:
A retrospective chart review was performed for all children who underwent diagnostic lung biopsy from 1/2009-12/2013. Patients who had blebectomy for spontaneous pneumothorax, or biopsy post lung transplant or for suspected cancer metastasis, were excluded. The indication for biopsy was classified as: those with new primary lung disease of unclear cause; known immunologic condition or history of organ transplant; known cancer; or those with bone marrow transplant. Biopsy results were classified as: (1)-new diagnosis, (2)-helpful, diagnosis confirmed or disease ruled-out, (3)-unhelpful, or (4)-insufficient. The primary outcome assessed was whether the biopsy led to a change in management. Secondary outcomes included biopsy-related complications, number of chest tube days, and whether the specimen was adequate or diagnostic. Statistical analysis included chi-square and ANOVA.
Results:
Eighty-three patients were identified (53% male, mean age 8.3±6.7 years). The majority (64%) underwent thoracoscopic biopsy; 19% had thoracotomy, and 17% had image-guided needle-based procedures. Comparisons of outcomes based on biopsy indication are presented in the Table. Overall, biopsy results were classified as: (1)-33(40%), (2)-41(49%), (3)-5(6%), (4)-4(5%), and led to a change in management in 33/83 (40%) children. Postoperatively, 16 (19%) patients were transferred to a higher level of care, and 27 (33%) experienced complications, including air-leak (n=20, 19%), need for reoperation (n=5; 4%), or bleeding (n=2, 2%). Eleven (13%) patients died, one directly attributable to surgical complications. Fifty-eight children (70%) had a chest tube postoperatively; 5 (6%) required additional tubes, and the median duration of chest tube use was 4 (range, 1-19) days.
Conclusion:
The risk-benefit ratio of lung biopsy in children with complicated respiratory and immunologic conditions appears to be favorable, in that clinically useful information is identified in nearly 90% of cases. Nevertheless, the procedure carries risks that must be considered in each patient by a multidisciplinary care team.
