Our Summary

This research paper is about the use of lung biopsy - a procedure to remove a small piece of lung tissue for examination - in diagnosing lung diseases in critically ill children in the pediatric intensive care unit. The researchers looked at children who had this procedure between 1995 and 2022. They found that the procedure was able to provide a diagnosis in 81% of the cases, especially in newborns. However, the reliability of the procedure seemed to decrease with the age of the child. The most commonly diagnosed condition was a type of lung disorder that affects development, followed by disorders related to a substance called surfactant which helps keep the air sacs in the lungs from collapsing. The procedure did have complications in about 29% of the cases, mostly involving severe bleeding, particularly in those who were also on a life support technique called ECMO. The researchers concluded that lung biopsy is a reliable diagnostic tool in critical situations, especially in newborns. However, they suggest further evaluation of the complications of the procedure, particularly in children over 2 years old and those on ECMO for more than 10 days.

FAQs

  1. What is the success rate of diagnosing lung diseases in children using lung biopsy, according to the research?
  2. How does the reliability of lung biopsy as a diagnostic tool change with the age of the child?
  3. What are the potential complications of the lung biopsy procedure in critically ill children?

Doctor’s Tip

A doctor might tell a patient about lung biopsy:

  • It is important to follow all pre-procedure instructions given by your healthcare provider, such as fasting before the procedure.
  • After the procedure, it is normal to experience some pain or discomfort at the biopsy site. Over-the-counter pain medications can help alleviate this discomfort.
  • It is important to closely monitor for any signs of infection, such as increased pain, redness, or swelling at the biopsy site.
  • Follow-up appointments with your healthcare provider are essential to discuss the results of the biopsy and any further treatment options.

Suitable For

Patients who are typically recommended for lung biopsy include those who are critically ill and have suspected lung diseases that cannot be diagnosed through less invasive methods such as imaging or lab tests. This may include patients with:

  1. Suspected lung cancer or other types of lung tumors
  2. Interstitial lung diseases, such as idiopathic pulmonary fibrosis or sarcoidosis
  3. Lung infections, such as pneumonia or tuberculosis
  4. Lung nodules or masses that are suspicious for cancer
  5. Diffuse alveolar hemorrhage
  6. Diffuse lung diseases of unknown etiology
  7. Suspected autoimmune lung diseases, such as lupus or rheumatoid arthritis
  8. Suspected pulmonary hypertension or pulmonary vascular diseases

In the case of critically ill children, lung biopsy may be recommended when there is a need for a definitive diagnosis to guide treatment in the pediatric intensive care unit. This may include newborns with respiratory distress syndrome or other neonatal lung disorders, as well as older children with severe respiratory failure or suspected rare lung diseases. It is important to weigh the potential benefits of the procedure in providing a diagnosis against the risks of complications, especially in critically ill patients.

Timeline

Before a lung biopsy:

  • Patient presents with respiratory symptoms such as cough, shortness of breath, or chest pain
  • Patient undergoes imaging tests such as chest X-ray or CT scan to identify abnormalities in the lungs
  • Patient may undergo pulmonary function tests to assess lung function
  • Doctor recommends a lung biopsy to obtain a tissue sample for further analysis

During a lung biopsy:

  • Patient is given local anesthesia to numb the area where the biopsy will be performed
  • Doctor uses a needle or surgical instrument to remove a small piece of lung tissue
  • Patient may experience some discomfort or pressure during the procedure
  • Tissue sample is sent to a lab for analysis

After a lung biopsy:

  • Patient may experience mild pain or discomfort at the biopsy site
  • Doctor monitors for any signs of complications such as bleeding or infection
  • Results of the biopsy are reviewed to determine a diagnosis and treatment plan
  • Patient may need follow-up appointments to discuss the results and next steps in their care.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a lung biopsy procedure?
  2. How will the procedure be performed and what can I expect during and after the biopsy?
  3. How long will it take to receive the results of the biopsy and how will they be communicated to me?
  4. Are there any alternative diagnostic tests or procedures that could be considered instead of a lung biopsy?
  5. What specific information do you hope to gain from the biopsy and how will it impact my treatment plan?
  6. How experienced are you in performing lung biopsies and what is your success rate in obtaining a diagnosis?
  7. Will I need to make any special preparations before the biopsy, such as fasting or stopping certain medications?
  8. Are there any specific instructions I should follow after the biopsy to ensure proper healing and reduce the risk of complications?
  9. How will the biopsy results be used to guide my ongoing care and treatment for lung disease?
  10. Are there any factors about my health history or current condition that may impact the safety or effectiveness of a lung biopsy in my case?

Reference

Authors: Levy Y, Bitton L, Sileo C, Rambaud J, Soreze Y, Louvrier C, Ducou le Pointe H, Corvol H, Hervieux E, Irtan S, Leger PL, Prévost B, Coulomb L’Herminé A, Nathan N. Journal: Pediatr Pulmonol. 2024 Apr;59(4):907-914. doi: 10.1002/ppul.26845. Epub 2024 Jan 2. PMID: 38165156