Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Pediatr Pulmonol. 2020 Apr;55(4):1050-1060. doi: 10.1002/ppul.24683. Epub 2020 Feb 10.
Pediatric patients with acute life-threatening consequences of interstitial and diffuse lung disease are often treated with empiric systemic corticosteroids, immune modulators, and/or broad antibiotic therapy. Histological evaluation of lung tissue represents the final necessary step in diagnosis-however, a definitive diagnosis may still remain elusive and medical therapies may not be changed following biopsy. We hypothesized that lung biopsy from pediatric patients with children's interstitial and diffuse lung disease (chILD) without a defined lesion on computed tomography (CT) imaging would guide diagnosis, but not substantially alter clinical management.
After IRB approval, patients who underwent a lung biopsy at a single large children's hospital between 2013 and 2018 were retrospectively reviewed. Patients without a defined lesion were included. Demographics, length of stay, oxygen-requirements, steroid, unique number of immune modulators, and antibiotics prebiopsy and postbiopsy were reviewed. Nonparametric data were compared by the Mann Whitney U and Kruskal Wallace tests and expressed as median with interquartile range. Decision tree alterations were analyzed by t test. P < .05 was significant.
Sixty-four patients underwent lung biopsy during the period. Nineteen (30%) did not have a defined lesion on CT scan, and were included. A significant difference was seen between prebiopsy, 2 weeks, and 2 months postbiopsy prednisone dosing (P = .03), while the number of unique immune modulators, antibiotics, type of oxygen support and FiO were not significantly different before or after obtaining biopsy results. Pathology results provided additional information in 12 of 19 (63%) patients which resulted in management changes.
Lung biopsy in chILD may guide clinical management, especially influencing the management of steroid dosing. Although on aggregate the number of antibiotics, immune modulators, mode of oxygen support and FiO did not differ significantly before and after biopsy, the pathologic evaluation provided diagnostic information that led to a variety of changes in therapeutic management in greater than half of the population.
患有危及生命的间质性和弥漫性肺部疾病的儿科患者通常接受经验性全身皮质类固醇、免疫调节剂和/或广泛抗生素治疗。肺组织的组织学评估是诊断的最后必要步骤-然而，即使进行了活检，最终诊断仍可能难以确定，并且可能不会改变医疗治疗。我们假设，在计算机断层扫描（CT）成像中没有明确病变的患有儿童间质性和弥漫性肺部疾病（chILD）的儿科患者的肺活检将指导诊断，但不会显著改变临床管理。
在获得机构审查委员会批准后，回顾性分析了 2013 年至 2018 年期间在一家大型儿童医院进行肺活检的患者。纳入了没有明确病变的患者。比较了患者的人口统计学、住院时间、氧需求、皮质类固醇、活检前和活检后的免疫调节剂和抗生素的数量。非参数数据采用 Mann Whitney U 和 Kruskal Wallace 检验进行比较，并表示为中位数和四分位距。通过 t 检验分析决策树的变化。P <.05 为有统计学意义。
在该期间，有 64 例患者进行了肺活检。19 例（30%）CT 扫描无明确病变，包括在内。活检前、2 周和 2 个月后泼尼松剂量有显著差异（P =.03），而活检前后独特免疫调节剂、抗生素、氧支持类型和 FiO 的数量无显著差异。在 19 例患者中的 12 例（63%）中，病理结果提供了更多信息，导致了治疗方案的改变。
在 chILD 中进行肺活检可能指导临床管理，尤其是影响皮质类固醇剂量的管理。尽管总体而言，活检前后抗生素、免疫调节剂、氧支持模式和 FiO 的数量无显著差异，但病理评估提供了诊断信息，导致超过一半的患者治疗管理发生了各种变化。
