The value of open lung biopsy in the immunosuppressed patient.

To evaluate the impact of the open lung biopsy on diagnosis and therapy in the immunosuppressed patient, 68 such patients managed at UCLA from 1975 to 1980 were reviewed. Most had hematologic malignancies, and all were severely immunosuppressed. The rates of surgical mortality (1 operative death) and morbidity were minimal. There were 10 diagnostic differences apparent when biopsy results were compared with autopsy findings in 28 autopsied patients. Therapy was initiated or modified in 19 patients on the basis of open lung biopsy. Forty-four patients lived 1 year or less, 14 for more than 1 year, and 10 were lost to follow-up. Of 42 patients with an untreatable disease on the basis of lung biopsy, 67% died and 33% lived to leave the hospital. Of 25 patients with a treatable disease, 56% died and 44% left the hospital. Of 28 autopsied patients, only 12 were receiving appropriate medication at time of death despite biopsy. The patient whose disease is generally characterized by brief survival like acute leukemia, and whose situation is most desperate, unfortunately benefits least from open lung biopsy. We conclude that this procedure has only a modest impact in the management of these critically ill patients and should be used conservatively.