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Chest Infections |

Transbronchial and Surgical Lung Biopsies in Bone Marrow Transplant Patients With Pulmonary Disease

Kathleen Lamb, MD; Lily Chang, BS; John Wagner, MD; Nathaniel Evans, MD; Rohit Kumar, MD; Boyd Hehn, MD; John Farber, MD; Abhinav Gabbetta, BS; Scott Cowan, MD
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Thomas Jefferson University Hospital, Department of Surgery, Philadelphia, PA


Chest. 2013;144(4_MeetingAbstracts):250A. doi:10.1378/chest.1704295
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Abstract

SESSION TITLE: AIDS/ Immunocompromised Patients Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary complications occur frequently after bone marrow transplantation (BMT) and are associated with increased morbidity and mortality. We reviewed our experience using transbronchial biopsy (TBB) and surgical biopsy (video assisted thoracoscopic surgery (VATS) or thoracotomy) for diagnosis of pulmonary disease in BMT patients.

METHODS: A retrospective review was conducted of patients who had undergone lung biopsy between January 2002 and December 2012 after BMT.

RESULTS: A total of 70 patients met inclusion criteria. Patients underwent either TBB (n=31) or surgical biopsy (VATS, n=20 or thoracotomy, n=9), with a subset requiring surgical biopsy after initial TBB (n=10). Biopsies were performed an average of 360.7 days from BMT, for indications including: pulmonary infiltrates/opacities (n=49; 70%), infection (n=8; 11.4%), nodules (n=6; 8.6%), and respiratory failure (n=6; 8.5%). While all surgical biopsies were successfully diagnostic, TBB was diagnostic in 31/41 (75.6%); the remaining 10 patients required surgical biopsy. Biopsy pathology revealed an inflammatory process in 43 patients (61.4%), including non-specific interstitial pneumonitis, diffuse alveolar hemorrhage, bronchiolitis obliterans, sarcoidosis and idiopathic pneumonia syndrome. Other diagnoses included infection (invasive aspergillosis, Pneumocystis carinii or Cytomegalovirus pneumonia; n=13; 18.6%), lymphocytic bronchitis/alveolitis (n=8; 11.4%), and recurrence of hematologic malignancy (n=6; 8.5%). Complications after TBB included post-procedure pneumothoraces requiring chest tube placement (n=2). In patients treated surgically +/- TBB, prolonged intubation was the most common complication (n=3 surgery; n=2 TBB/surgery). Additionally, one surgical patient developed a hemothorax requiring surgical evacuation; another developed massive subcutaneous emphysema. Thirty day mortality rates were 29% after TBB and 33.3% after surgical biopsy. No mortalities were directly related to biopsies.

CONCLUSIONS: Lung biopsy is safe and effective in BMT patients; however, overall prognosis is poor in patients requiring biopsy. TBB is diagnostic in 75.6% of patients with a low complication rate. Surgical biopsy can be performed with acceptable morbidity and mortality.

CLINICAL IMPLICATIONS: Review of this highly selected data of patients who are on average 1 year from BMT suggests that TBB may be used as a first line diagnostic procedure.

DISCLOSURE: The following authors have nothing to disclose: Kathleen Lamb, Lily Chang, John Wagner, Nathaniel Evans, Rohit Kumar, Boyd Hehn, John Farber, Abhinav Gabbetta, Scott Cowan

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