Diagnostic value of transbronchial, thoracoscopic, and open lung biopsy in immunocompetent children with chronic interstitial lung disease

• Published in: The Journal of pediatrics Vol. 131; no. 4; pp. 565 - 569
• Main Authors: Fan, Leland L., Kozinetz, Claudia A., Wojtczak, Henry A., Chatfield, Barbara A., Cohen, Alan H., Rothenberg, Steven S.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.10.1997; Elsevier
• Subjects: Adolescent; Age Factors; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biopsy; Child; Child, Preschool; Chronic Disease; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Humans; Infant; Infant, Newborn; Intensive care medicine; Lung Diseases, Interstitial - diagnosis; Lung Diseases, Interstitial - immunology; Medical sciences; Prospective Studies; Thoracoscopy; ILD; VAT; OLB; TBB; Human; Performance evaluation; Lung disease; Respiratory disease; Thoracotomy; Chronic; Biopsy; Surgery; Interstitial pneumonitis; Endoscopy; Diagnosis; Child; Comparative study; Thoracoscopy
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(97)70063-5

Objectives: To evaluate the diagnostic value of transbronchial biopsy (TBB), video-assisted thoracoscopy (VAT), and open lung biopsy (OLB) in immunocompetent children with chronic, diffuse infiltrates; to identify factors that may predict diagnosis in children requiring biopsy; to determine whether age, number of biopsies, or type of procedure are associated with diagnostic yield in children undergoing transthoracic biopsy; and to compare morbidity of VAT with that of OLB. Study design: As part of a prospective, descriptive study to define the clinical spectrum of pediatric interstitial lung disease, 30 immunocompetent children required TBB, VAT, and/or OLB for diagnosis of diffuse infiltrates. We reviewed and analyzed the following clinical variables: age; preoperative diagnosis; type of procedure; number of lobes undergoing biopsies; durations of surgery, chest tube insertion, and hospitalization; tissue diagnosis; and complications. Results: Specific diagnoses were made in 50%, 60%, and 53% of patients undergoing TBB, VAT, and OLB, respectively. A variety of rare disorders was found, and tissue diagnosis confirmed the preoperative diagnosis in 25% of all procedures. For patients who underwent transthoracic biopsy, patient age of greater than 24 months was significantly associated with increased diagnostic yield, but the number of lobes biopsied and type of procedure were not. VAT was associated with shorter operating time, chest tube placement, and hospitalization when compared with OLB. The complications of VAT and OLB were comparable. Conclusion: Lung biopsy is an important tool for the diagnosis of interstitial lung disease in immunocompetent children, but the diagnosis of many children, particularly those aged 2 years or younger, remains uncertain. (J Pediatr 1997;131:565-9)