Open lung biopsy in children.

Abstract

The diagnosis of obscure pulmonary conditions has improved in recent years with the use of procedures such as pulmonary function tests, pulmonary angiography, skin tests, and bacteriologic cultures. However, in spite of these techniques, many cases of diffuse pulmonary disease still remain undiagnosed. Recognition of the cause of the pathologic process becomes increasingly important as new therapeutic agents are described and contraindications to certain forms of treatment are formulated. A definite diagnosis also has a prognostic value. Needle lung biopsy has been of assistance, but complications of the procedure are more common and serious than needle biopsy of other organs, and the biopsied material is often quantitatively insufficient. Since Klassen, Anylan, and Curtis (1) developed a method of open lung biopsy in 1949, this technique has been favored by most thoracic surgeons because of its relative simplicity and low incidence of complications. Most recent reports have concerned adult patients only, open lung biopsy being most useful in confirming or establishing the diagnosis of diffuse pulmonary diseases such as silicosis, sarcoidosis, granulomatous diseases, tuberculosis, and primary and secondary cancers of the lung. These reports all confirm that this technique of open lung biopsy is a relatively innocuous procedure except in critically ill patients; its diagnostic yields are high, and it is of great value in deciding the clinical management of the patients. The purpose of this paper is to report, discuss, and analyze the experience of open lung biopsy in patients at The Hospital for Sick Children of Toronto in the past 15 years.