Transbronchial and Surgical Lung Biopsies in Bone Marrow Transplant Patients with Pulmonary Disease
Kathleen M. Lamb1, Lily C. Chang2, John Wagner1, Nathaniel R. Evans1, Rohit Kumar1, Boyd Hehn1, John Farber1, Abhinav Gabbetta1, Scott W. Cowan1. 1Thomas Jefferson University Hospital, Philadelphia, PA, 2Jefferson Medical College, Philadelphia, PA
OBJECTIVE: Pulmonary complications occur frequently after bone marrow transplantation (BMT) and are associated with increased morbidity and mortality. We reviewed our experience using transbronchial biopsy (TBB) and surgical biopsy (SB) for diagnosis of pulmonary disease in BMT patients.
METHODS: A retrospective review was conducted of BMT patients who had undergone lung biopsy between 1/2002 and 12/2012.
RESULTS: Seventy patients met inclusion criteria. Patients underwent either TBB (n=31) or SB (video assisted thoracoscopy, VATS, n=20 or thoracotomy, n=9). Ten patients required SB after initial TBB. Biopsies indications included: pulmonary infiltrates/opacities (n=49; 70%), infection (n=8; 11.4%), nodules (n=6; 8.6%), and respiratory failure (n=6; 8.5%). While all SBs were successfully diagnostic, TBB was diagnostic in 31/41 (75.6%); the remaining 10 required SB. Biopsy pathology revealed inflammatory processes (n-43; 61.4%), infection (n=13; 18.6%), lymphocytic bronchitis/alveolitis (n=8; 11.4%), and recurrence of hematologic malignancy (n=6; 8.5%). Complications after TBB included pneumothoraces requiring chest tube placement (n=2). In patients treated surgically +/- TBB, prolonged intubation was the most common complication (n=3 SB; n=2 TBB/SB). Thirty day mortality rates were 29% after TBB, 33.3% after SB. No mortalities were directly related to biopsies.
CONCLUSION: Lung biopsy is safe and effective in BMT patients; however, prognosis is poor in patients requiring biopsy. TBB is diagnostic in 75.6% of patients with a low complication rate. SB can be performed with acceptable morbidity and mortality. Review of this data of patients who are on average 1 year from BMT suggests that TBB may be used as a first line diagnostic procedure.