A critical review of the use of open lung biopsy in the management of the oncologic patient with acute pulmonary infiltrates.

In a retrospective review, 28 open lung biopsies from 27 oncology patients with acute pulmonary infiltrates were evaluated. The operative complication rate was 28%, and the operative mortality 4%. Infection caused 57% of the infiltrates (16 cases); 87% of the infections were secondary to either Pneumocystis carinii or a viral infection. Two patients had bacterial pneumonia. Sixteen of these cases survived (37%). All but one survivor had Pneumocystis carinii. A nonspecific pneumonitis either with or without associated fibrosis caused 39% of the infiltrates (11 cases). Four of these patients survived (36%). Two patients had histologic evidence of residual tumor, one secondary to leukemia and the other to a lymphoma. One of these patients who also had Pneumocystis carinii survived. This study confirms the results of several other studies. Open lung biopsy in the oncology patient with an acute pulmonary infiltrate rarely establishes the presence of a treatable lesion other than Pneumocystis carinii, a diagnosis that can usually be established by bronchoscopy. The indications for open lung biopsy are therefore limited.