The utility of open lung biopsy in patients with hematologic malignancies

The yield and impact of open lung biopsies in patients with hematologic mal ignancies and unexplained pulmonary processes were assessed and analyzed to determine factors that affected the yield. Records of 63 patients with hem atologic malignancy, who underwent 67 open lung biopsies for diagnosis of a n unknown pulmonary process from 1996 to 1998 at Memorial Sloan-Kettering C ancer Center, were retrospectively reviewed. A specific diagnosis was found in 41 (62%) of the biopsies. Changes in therapy were made in 37 (57%) of p atients after biopsy results, but in 69% of those with a specific diagnosis . Survival at 30 and 90 d was increased in those with specific rather than a nonspecific pulmonary diagnosis. The factor most predictive of finding a specific diagnosis was the presence of a focal rather than a diffuse radiog raphic abnormality (79% versus 36%, p = 0.003). Neutropenic patients or tho se on mechanical ventilation had a low chance of finding a specific diagnos is. Having received pulmonary toxic chemotherapy in the 6 mo before the bio psy was associated with finding a nonspecific lung injury. Specific pulmona ry diagnoses found were inflammatory diseases in 23% of cases, infections i n 21%, and malignancy in 18%. Bronchiolitis obliterans with organizing pneu monia (BOOP) was the most common inflammatory disorder and fungi and bacter ia were the most frequent infectious pathogens. Complications occurred in 1 3% of the biopsies, including five patients who required mechanical ventila tion postprocedure; one death was associated with the biopsy. The risk was increased in those with less than 50,000 platelets. Complications were simi lar with video-assisted thoracoscopy (VATS) compared with thoracotomy. We c onclude that open lung biopsy in patients with hematologic malignancy has a significant yield and impact on management of patients with hematologic ma lignancy.