THE ROLE OF OPEN LUNG-BIOPSY IN THE MANAGEMENT AND OUTCOME OF PATIENTS WITH DIFFUSE LUNG-DISEASE

Background. Open lung biopsy (OLB) has long been considered the gold s tandard for the diagnosis of parenchymal lung disease. With recent adv ances in computed tomographic imaging and diagnostic techniques (eg, b ronchoscopy), we thought it necessary to reevaluate the role of OLB in the management of patients with interstitial lung disease. Methods. W e carried out a retrospective analysis of 103 OLBs performed at Hadass ah University Hospital, Jerusalem, and Carmel Medical Center, Haifa, b etween 1980 and 1994. Data gathered included demographic information, underlying condition, indications for biopsy, diagnosis before biopsy, final diagnosis, change in therapy, and mortality. ''Benefit'' was de fined as a change in therapy resulting in survival. Results. There wer e 45 immunocompetent patients (group 1), 39 immunocompromised patients (group 2), and 26 children (group 3), 7 of whom were included in grou p 2 for analysis. Overall, a diagnosis was reached after OLB in 85% of patients. An unexpected diagnosis was reached in 52%, and a change in therapy was instituted in 46%. The overall mortality rate was 20%. In group 1, the mortality rate was 13%, and ''benefit'' from OLB was rea ched in only 18%. In group 2, the mortality rate was 39%, and ''benefi t'' was achieved in 46%, and in group 3, the mortality rate was 12% an d ''benefit'', 50%. Conclusions. Open lung biopsy is an excellent diag nostic technique. In immunocompetent patients, the ''benefit'' is rela tively low, as therapy (corticosteroids) is frequently used after biop sy. In immunocompromised patients, therapy changes substantially after OLB, but mortality is high. Therefore, OLB should be reserved for pat ients in whom the diagnosis is likely to lead to a change in therapy a nd in patients in whom the underlying condition has a reasonable progn osis according to the clinical impression by the attending physician. (C) 1998 by The Society of Thoracic Surgeons.