Lung biopsy: Is it necessary?

Objective: Lung biopsy is associated with substantial mortality rates. We r eviewed our experience with this operation, primarily in patients with immu nocompetence, to determine whether the results justify the continued perfor mance of this procedure. Methods: We conducted a retrospective review of al l diagnostic lung biopsies performed at 3 university-affiliated hospitals b etween July 1, 1992, and December 31, 1998, Results: There were 75 patients : 25 patients were treated electively, 17 were treated on an urgent basis, 27 patients on an emergency basis, and the urgency was unclear in 6 patient s, Significant beneficial therapeutic changes were made in 15 of 25 electiv e procedures (60%), in 16 of 17 urgent procedures (94%), and in 11 of 27 em ergency procedures (41%; P = .001), Significant beneficial therapeutic chan ges consisted of immunosuppression in 13 of 15 (87%) patients treated on an elective basis, in 9 of 16 (56%) treated on an urgent basis, and in 9 of 1 1 (82%) treated on an emergency basis in whom therapy was altered (P = .14) , Operative death was 0 of 25 for elective operations (0%), 3 of 17 for urg ent operations (18%), and 14 of 26 for emergency operations (54 %). Multiva riable analysis of operative death showed urgency to be the only significan t predictor of death (P = .002), Conclusions: In patients with immunocompet ence, elective and urgent lung biopsies have acceptable operative mortality rates and frequently result in important beneficial therapeutic changes. C onsequently biopsies are appropriate in these patients. Emergency biopsies are associated with high operative mortality rates and rarely result in a t herapeutic change other than immunosuppression, These patients should not u ndergo lung biopsy if they are in stable condition and should be treated em pirically with immunosuppression without operation if their condition is de teriorating.