Utility of surgical lung biopsy in immunocompromised patients

Purpose: To determine the utility of surgical lung biopsy(SLB) in immunocompromised patients. Methods: Retrospective chart review, June 1995 through December 1997. Results: Twenty-three immunocompromised patients underwent SLB, twenty-two via video assisted thoracic surgery(VATS) and one via open lung biopsy(OLB). There were nineteen men and four women. The age range of all patients was 21 to 84 years with an average of 41 years. Eight patients had AIDS, twelve had hematologic malignancies, one had metastatic colon cancer, one had leiomyosarcoma, and one had previously diagnosed adenocarcinoma of the lung. All except four patients, had undergone fiberoptic bronchoscopy with bronchoalveolar lavage with or without transbronchial biopsy. In only four cases were the SLB results inconclusive. Two of those patients, one with AML and one with myelodysplasia subsequently died. The other two were treated with broad-spectrum antibiotics and sent home. Of the nineteen patients in whom SLB was diagnostic, seven died and twelve were treated and eventually sent home. In eleven of the patients in whom the SLB was diagnostic, therapy was changed or altered. Despite therapy, four of them died. Care was withdrawn from three others who subsequently died. Eight of the patients that died were intubated shortly before or after the SLB was performed, secondary to progressive respiratory failure. Conclusions: While SLB is a very good diagnostic tool, it may not affect survival of an immunocompromised patient. There does not appear to be any accurate means of predicting outcome after performance of SLB, however it appears that respiratory failure requiring intubation is a poor prognostic sign. Clinical Implications: Our study sample was small, and the patients were quite varied. There will need to be further investigation into the overall diagnostic yield of SLB, particularly VATS, in immunocompromised patients.