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The Utility of Open Lung Biopsy in Patients With Diffuse Pulmonary Infiltrates as Related to Respiratory Distress, Its Impact on Decision Making by Urgent Intervention, and the Diagnostic Accuracy Based on the Biopsy Location

I-Feng Lin, DrPH

Ying-Huang Tsai, MD

Janine R. E. Vintch, MD

Leuo-Chuan Pang, MD

Patients with diffuse pulmonary infiltrates (DPI), especially those who present with respiratory distress (RD), may benefit from early open lung biopsy (OLB) to guide management. Benefits of urgent OLB would be expected by saving the time to reach accurate specific diagnoses. The objectives of this study were (1) to evaluate the impact of OLB between patients presenting with and without RD, (2) to focus on the impact of an urgent OLB as compared to an elective OLB, and (3) to compare the different yields of specific diagnoses in the middle lobe or lingula as compared to the other lobes. Thirty-four patients (17 patients presented with RD and 17 patients did not) with an average age of 43 years who presented with DPI were selected to undergo an OLB. An urgent OLB was performed in 11unselected patients. Twelve specimens from the middle lobe or lingula were compared to 25 specimens from the other lobes. The impact of the OLB results on decision making did not differ significantly between patients with and without RD. Patients with RD suffered a higher in-hospital mortality rate, OLB-related complications, and longer mechanical ventilation requirements than the patients without RD. The impact on decision making and complications between urgent OLB and elective OLB was comparable. The diagnostic yield from biopsy sites in the middle lobe or lingula resembled those specimens from the other lobes. The authors conclude that OLB may play a role in decision making for patients with DPI. However, OLB makes no difference in decision making between patients with and without RD. Patients with RD undergoing OLB procedures may suffer a poorer outcome. Urgent OLB may not benefit patients with DPI in decision making. The biopsy site does not appear to affect the accuracy of the diagnostic yield from an OLB procedure.

Key Words: limited thoracotomy • diffuse pulmonary infiltrates • multiple pulmonary nodules • respiratory distress • in-hospital mortality

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