Walker W A, Cole F H, Khandekar A, Mahfood S S, Watson D C
University of Tennessee Health Sciences Center, Memphis.
J Thorac Cardiovasc Surg. 1989 Apr;97(4):534-40.
The decision to perform open lung biopsy in the evaluation of a diffuse pulmonary infiltrate is based on the probability that this examination will yield specific information that may lead to a change in treatment. The role of this procedure remains controversial and many clinicians are reluctant to allow this invasive procedure without assurances that results will lead to a change in therapy for a significant number. To evaluate the impact of open lung biopsy on diagnosis and treatment of diffuse pulmonary infiltrates, we conducted a retrospective review of 61 patients undergoing this procedure at three university-affiliated hospitals during a recent 7-year period. There were 37 men and 24 women; average age was 57 years. Biopsy yielded a specific diagnosis in 21 (34%) patients and a change in therapy in 33 (54%) patients. A complication developed in 11 (18%) patients, directly related to the biopsy procedure in six (10%). Eight patients died. The immune status in 22 (36%) patients was compromised. A specific diagnosis was obtained in 13 (59%) immunocompromised patients and a change in therapy occurred in 17 (77%) of these patients after biopsy. A specific diagnosis was obtained in only eight (21%) of the 39 noncompromised patients and therapy was changed in 16 (41%) patients in this group (p less than 0.02 compromised versus noncompromised). Morbidity and mortality were not significantly different between the two groups. A nonspecific diagnosis led to a change in therapy as frequently as a specific diagnosis in both compromised and noncompromised groups. Open lung biopsy in the patient with a diffuse pulmonary infiltrate is an accurate diagnostic tool and frequently leads to a change in patient treatment. The procedure can be performed with acceptable morbidity and mortality in immunocompromised and noncompromised patients.
在评估弥漫性肺浸润时决定进行开胸肺活检，是基于这样一种可能性，即该检查可能会提供特定信息，从而导致治疗方案的改变。该操作的作用仍存在争议，许多临床医生在没有确信结果会使相当一部分患者的治疗发生改变之前，不愿采用这种侵入性操作。为了评估开胸肺活检对弥漫性肺浸润诊断和治疗的影响，我们对最近7年期间在3所大学附属医院接受该操作的61例患者进行了回顾性研究。其中男性37例，女性24例；平均年龄57岁。活检在21例（34%）患者中得出了明确诊断，在33例（54%）患者中导致了治疗方案的改变。11例（18%）患者出现了并发症，其中6例（10%）与活检操作直接相关。8例患者死亡。22例（36%）患者的免疫状态受损。13例（59%）免疫受损患者在活检后获得了明确诊断，其中17例（77%）患者的治疗方案发生了改变。在39例免疫未受损患者中，只有8例（21%）获得了明确诊断，该组中有16例（41%）患者的治疗方案发生了改变（免疫受损组与免疫未受损组相比，P<0.02）。两组的发病率和死亡率无显著差异。在免疫受损组和免疫未受损组中，非特异性诊断导致治疗方案改变的频率与特异性诊断相同。对于弥漫性肺浸润患者，开胸肺活检是一种准确的诊断工具，并且常常会导致患者治疗方案的改变。该操作在免疫受损和免疫未受损患者中进行时，发病率和死亡率均可接受。
