Original Article
Lung biopsy for chronic pulmonary disease in children

https://doi.org/10.1016/j.jpedsurg.2013.10.026Get rights and content

Abstract

Introduction and objectives

Lung biopsy is frequently used in the management of children with chronic pulmonary disease to obtain a histological diagnosis. We further evaluate the role of lung biopsy by reviewing our experience of this procedure.

Methods

A retrospective case-note review was carried out of all patients in our regional service under 16 years who underwent a lung biopsy from 1998 to 2011.

Results

Thirty-three children (12 boys) (median 5 years 5 months, range 2 months to 16 years) underwent lung biopsy in the period studied. Following the procedure, 17 patients required ventilation on the intensive care unit for a median of two days (range 1–56 days). Complication rate was 30% (10/33); seven simple pneumothoraces, one tension pneumothorax, and one pneumonia (one child experienced more than one complication). The operative mortality was 12% (4/33). Three children (9%) died within 28 days of surgery. Twenty-six (79%) biopsies provided a definitive histological diagnosis. In 16 (48%) children, the working diagnosis and treatment were changed following lung biopsy.

Conclusion

Lung biopsy has an important role in the management of children with chronic pulmonary disease. However, it carries significant risks which must be considered when assessing the need for histological diagnosis.

Section snippets

Methods

All children under sixteen years of age undergoing lung biopsy in our institution between 1998 and 2011 were identified using the in-house audit system and their case notes reviewed retrospectively. Data were collected on patient demographics, pre- and post-biopsy diagnosis and treatment, histological findings, operative complications and outcome.

All patients were under the care of a pediatric respiratory physician and had typically undergone a thorough medical diagnostic work-up. Only in cases

Results

Thirty-three patients underwent lung biopsy in the period studied including 21 females and 12 males. The median age was 5 years 5 months, (range 2 months to 16 years). All patients had a pre-operative CT scan of their thorax and all but three had undergone bronchoscopy and bronch-alvelolar lavage (BAL).

In five cases, a thoracoscopic approach was attempted but this was abandoned in four owing to an inability to safely deflate the lung and create a working space in the thorax. Ultimately, 32 children

Discussion

We present the thirteen-year experience of lung biopsy in a tertiary paediatric surgical centre. This represents one of the largest published series of this procedure in this age group. The findings of five similar studies are summarised in Table 3.

The complication rate of 24% and mortality rate of 12% in our series are comparable with others’ findings. However, when comparing retrospective studies it is hard to be sure definitions of complications and mortality are directly comparable. We have

References (13)

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