Me. Ellis et al., OPEN LUNG-BIOPSY PROVIDES A HIGHER AND MORE SPECIFIC DIAGNOSTIC YIELDCOMPARED TO BRONCHOALVEOLAR LAVAGE IN IMMUNOCOMPROMISED PATIENTS, Scandinavian journal of infectious diseases, 27(2), 1995, pp. 157-162
In order to examine the feasibility and safety of undertaking a larger
prospective study to compare the diagnostic yield from concurrent ope
n lung biopsy (OLB) and bronchoalveol ar lavage (BAL) in febrile neutr
openic patients with pulmonary infiltrates and the impact of such know
ledge on clinical outcome, a pilot exploratory study was performed. 13
immunocompromised patients (mainly with haematological malignancy or
bone marrow transplantation recipients) were investigated. At least on
e diagnostic finding in 12 of 13 patients was provided by OLB compared
to 4 of 13 patients by BAL. BAL provided 7 specific diagnoses (pneumo
cystis 1, fungal infection 3, bacterial pneumonia 1, pulmonary haemorr
hage 2) whilst OLB provided 12 specific diagnosis (CMV 2, pneumocystis
3, fungal infection 1, bacterial pneumonia 1, pulmonary haemorrhage 4
, pulmonary embolism 1). Five patients with nonspecific interstitial/a
lveolar inflammation were diagnosed only by OLB. The concordance that
the exact same specific diagnoses present in the OLB were found in the
BAL was zero. There were 2 minor complications (1 wound infection by
OLB, 1 moderate haemorrhage by BAL). Mortality at 28 days was 8 of 13
patients which in no case was related to either procedure. We suggest
that OLB is a safe procedure in such patients, provides superior and m
ore complete diagnostic information compared to BAL and a larger contr
olled study to investigate the impact of early OLB on the outcome of t
hese patients appears to be justified.