Utility of open surgical lung biopsy in children

Abstract

Introduction: Open lung biopsy (OLB) is commonly used to obtain a definitive histological diagnosis in children with respiratory disorders. This allows correct treatment pathways to be followed and also guides discussions surrounding prognosis. Aims: To define the epidemiology of OLB at our large tertiary specialist regional centre. To determine if OLB is useful in obtaining a conclusive diagnosis in a child with complex respiratory disease. Method: Retrospectively, all lung biopsies undertaken in children under 18 years from 2006 to 2016 were reviewed. In total, 179 OLB episodes were identified. Biopsies confirming congenital thoracic malformations or pulmonary metastatic disease were excluded. Results: 42 patients had 44 episodes of OLB in the period studied. A definitive histological diagnosis was reached in 35 (79%) cases. In 9 cases, non-specific changes were reported; therefore the underlying aetiology was not identified. Of the 35 diagnostic cases, 13 were consistent with interstitial lung disease (ILD), 11 confirmed empyema (biopsy routinely sent during decortication surgery), 5 confirmed invasive infections, 4 were diagnostic of immunological /rheumatological disorders and 2 confirmed structural lung disease in cystic fibrosis patients. In total 9 patients died of their underlying disease but there were no deaths directly attributable to OLB surgery. Conclusion: OLB although undertaken rarely, remains a useful investigation in the management of children with respiratory disease. It not only contributes substantially in obtaining a definitive diagnosis, allowing targeted treatment but also provides valuable prognostic information so families are clear on the likely progress of the disease and can plan for palliation where appropriate.