Bronchoscopy and Surgical Lung Biopsy for the Diagnosis and Management of Pulmonary Infiltrates in Immunocompromised Hosts.

Park, Sang Joon; Kang, Soo Jung; Koh, Young Min; Suh, Gee Young; Kim, Hojoong; Kwon, O Jung; Lee, Hong Ghi; Rhee, Chong H; Chung, Man Pyo

doi:1999.47.2.195

Tuberc Respir Dis > Volume 47(2); 1999 > Article

Original Article

Tuberculosis and Respiratory Diseases 1999;47(2):195-208.
DOI: https://doi.org/10.4046/trd.1999.47.2.195 Published online August 1, 1999.

Bronchoscopy and Surgical Lung Biopsy for the Diagnosis and Management of Pulmonary Infiltrates in Immunocompromised Hosts.

Sang Joon Park, Soo Jung Kang, Young Min Koh, Gee Young Suh, Hojoong Kim, O Jung Kwon, Hong Ghi Lee, Chong H Rhee, Man Pyo Chung

¹Division of Pulmonolgy, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. mpchung@smc.samsung.co.kr
²Division of Hematology/Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
³Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

BACKGROUND
Pulmonary infiltrate in immunocompromised hosts has many infectious and non- infectios etiologies. To evaluate the diagnostic yield and therapeutic implication of two invasive diagnostic methods, such as bronchoscopy and surgical lung biopsy, we performed retrospective analysis of these patients. METHODS: All immunocompromised patients admitted to Samsung Medical Center from October 1995 to August 1998 who underwent bronchoscopy and/or surgical lung biopsy for the diagnosis of pulmonary infiltrates were included in this study. Confirmative diagnostic yield, the rate of changed therapeutic plan and patients' survival were investigated. RESULTS: Seventy-five episodes of pulmonary infiltrates developed in 70 patients(M : F = 46 : 24, median age 51). Underlying diseases of patients were hematologic malignancy(n=30), organ transplantatio n(n=11), solid tumor(n=12), connective tissue disease(n=6) and others. Confirmative diagnosis was made in total 53 cases (70.7%), of which 70.2% had infectious etiology. Diagnostic yields of bronchoscopy, bronchoalveolar lavage(BAL), transbronchial lung biopsy(TBLB) and surgical lung biopsy were 35.0%(21/60), 31.4%(16/51), 25.0%(9/36) and 80.0%(20/25). Therapeutic plan was changed in 40%(24/60) of patients after bronchoscopy and in 36%(9/25) of patients after surgical lung biopsy. More patients survived (84.4% vs 60.5%, p=0.024) when therapeutic plan was changed after invasive diagnostic study. CONCLUSION: Bronchoscopy and surgical lung biopsy are helpful for the therapeutic implication of pulmonary infiltrates in immunocompromised hosts. Large-scale prospective case-control study may further clarify their limitation and usefulness.

Key Words: Immunocompromised host, Pulmonary infiltrate, Bronchoscopy, Surgical lung biopsy