Transbronchial Biopsy in the Diagnosis of Pulmonary Infiltrates in Immunocompromised Patients
Bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) frequently are performed in the investigation of immunocompromised patients with lung disorders. The risk-benefit ratio of TBB currently is debated, since several authors have found that the less invasive BAL may provide as much informatio...
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| Veröffentlicht in: | Chest 1995-01, Vol.107 (1), p.101-106 |
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| creator | Cazzadori, Angelo Perri, Giovanni Di Todeschini, Giuseppe Luzzati, Roberto Boschiero, Luigi Perona, Giuseppe Concia, Ercole |
| description | Bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) frequently are performed in the investigation of immunocompromised patients with lung disorders. The risk-benefit ratio of TBB currently is debated, since several authors have found that the less invasive BAL may provide as much information as TBB, with the avoidance of some biopsy-related side effects. We retrospectively evaluated 157 instances of bronchoscopy carried out on 142 immunocompromised patients, with both BAL and TBB performed in every case. Immunosuppressant conditions were HIV infection (79), hematologic malignancies (36), and antirejection therapy in renal transplant recipients (27). Transbronchial biopsy provided a diagnostic yield significantly higher than that obtained by BAL in all categories investigated; diagnostic rates were 77.3% for TBB and 47.6% for BAL (p |
| doi_str_mv | 10.1378/chest.107.1.101 |
| format | Article |
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The risk-benefit ratio of TBB currently is debated, since several authors have found that the less invasive BAL may provide as much information as TBB, with the avoidance of some biopsy-related side effects. We retrospectively evaluated 157 instances of bronchoscopy carried out on 142 immunocompromised patients, with both BAL and TBB performed in every case. Immunosuppressant conditions were HIV infection (79), hematologic malignancies (36), and antirejection therapy in renal transplant recipients (27). Transbronchial biopsy provided a diagnostic yield significantly higher than that obtained by BAL in all categories investigated; diagnostic rates were 77.3% for TBB and 47.6% for BAL (p <0.001) in patients with HIV infection, 55 and 20% (p <0.001) in patients with hematologic malignancies, and 57.5 and 27.2% (p <0.001) in renal transplant recipients. Looking at the whole series, the diagnostic rates of TBB and BAL were 67.5 and 36.3%, respectively (p <0.001), with a total additional yield of 33% provided by TBB, while in only 2% of cases BAL gave rise to diagnostic information not achieved by TBB. Considering that side effects followed TBB at a negligible rate (2.5%), we believe that TBB should be routinely carried out in these patients once the diagnostic strategy has been oriented to bronchoscopy.</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.107.1.101</identifier><identifier>PMID: 7813258</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; AIDS/HIV ; Biological and medical sciences ; Biopsy, Needle - adverse effects ; bronchoalveolar lavage ; Bronchoalveolar Lavage Fluid ; Bronchoscopy ; Endoscopy ; Female ; HIV Infections - immunology ; Humans ; Immunocompromised Host ; immunocompromised patients ; Immunosuppressive Agents - administration & dosage ; Investigative techniques, diagnostic techniques (general aspects) ; Kidney Transplantation - immunology ; Leukemia - immunology ; Lung - pathology ; Lung Diseases - diagnosis ; Lung Neoplasms - diagnosis ; Lymphoma - immunology ; Male ; Medical sciences ; Middle Aged ; Opportunistic Infections - diagnosis ; Retrospective Studies ; transbronchial biopsy</subject><ispartof>Chest, 1995-01, Vol.107 (1), p.101-106</ispartof><rights>1995 The American College of Chest Physicians</rights><rights>1995 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-520818cd86cfe8d9f5173afb09b405ce5b00e31a5264425d361edd19dfc3ad983</citedby><cites>FETCH-LOGICAL-c477t-520818cd86cfe8d9f5173afb09b405ce5b00e31a5264425d361edd19dfc3ad983</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,4009,27902,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3418454$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7813258$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cazzadori, Angelo</creatorcontrib><creatorcontrib>Perri, Giovanni Di</creatorcontrib><creatorcontrib>Todeschini, Giuseppe</creatorcontrib><creatorcontrib>Luzzati, Roberto</creatorcontrib><creatorcontrib>Boschiero, Luigi</creatorcontrib><creatorcontrib>Perona, Giuseppe</creatorcontrib><creatorcontrib>Concia, Ercole</creatorcontrib><title>Transbronchial Biopsy in the Diagnosis of Pulmonary Infiltrates in Immunocompromised Patients</title><title>Chest</title><addtitle>Chest</addtitle><description>Bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) frequently are performed in the investigation of immunocompromised patients with lung disorders. The risk-benefit ratio of TBB currently is debated, since several authors have found that the less invasive BAL may provide as much information as TBB, with the avoidance of some biopsy-related side effects. We retrospectively evaluated 157 instances of bronchoscopy carried out on 142 immunocompromised patients, with both BAL and TBB performed in every case. Immunosuppressant conditions were HIV infection (79), hematologic malignancies (36), and antirejection therapy in renal transplant recipients (27). Transbronchial biopsy provided a diagnostic yield significantly higher than that obtained by BAL in all categories investigated; diagnostic rates were 77.3% for TBB and 47.6% for BAL (p <0.001) in patients with HIV infection, 55 and 20% (p <0.001) in patients with hematologic malignancies, and 57.5 and 27.2% (p <0.001) in renal transplant recipients. Looking at the whole series, the diagnostic rates of TBB and BAL were 67.5 and 36.3%, respectively (p <0.001), with a total additional yield of 33% provided by TBB, while in only 2% of cases BAL gave rise to diagnostic information not achieved by TBB. Considering that side effects followed TBB at a negligible rate (2.5%), we believe that TBB should be routinely carried out in these patients once the diagnostic strategy has been oriented to bronchoscopy.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>AIDS/HIV</subject><subject>Biological and medical sciences</subject><subject>Biopsy, Needle - adverse effects</subject><subject>bronchoalveolar lavage</subject><subject>Bronchoalveolar Lavage Fluid</subject><subject>Bronchoscopy</subject><subject>Endoscopy</subject><subject>Female</subject><subject>HIV Infections - immunology</subject><subject>Humans</subject><subject>Immunocompromised Host</subject><subject>immunocompromised patients</subject><subject>Immunosuppressive Agents - administration & dosage</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Kidney Transplantation - immunology</subject><subject>Leukemia - immunology</subject><subject>Lung - pathology</subject><subject>Lung Diseases - diagnosis</subject><subject>Lung Neoplasms - diagnosis</subject><subject>Lymphoma - immunology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Opportunistic Infections - diagnosis</subject><subject>Retrospective Studies</subject><subject>transbronchial biopsy</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1v1DAQhi0EKkvhzAkpB8QtW0-cxPYRytdKleihHJHl2JPGlWMvdgLqv8fLrlZcuIw1mnfmnXlMyGugW2BcXJkJ87IFyrdQIjwhG5AMata17CnZUApNzXrZPCcvcn6gJQfZX5ALLoA1ndiQH3dJhzykGMzktK8-uLjPj5UL1TJh9dHp-xCzy1Ucq9vVzzHo9Fjtwuj8kvSC-aDczfMaoonzPsXZZbTVrV4chiW_JM9G7TO-Or2X5PvnT3fXX-ubb1921-9vatNyvtRdQwUIY0VvRhRWjh1wpseByqGlncFuoBQZ6K7p27bpLOsBrQVpR8O0lYJdknfHuWWDn2shosoeBr3XAeOaFecAXLZQhFdHoUkx54Sj2ic3l5sUUHUAqv4CLRlXUOKh481p9DrMaM_6E8FSf3uq62y0HwtO4_JZxloQbfmMs_Hk7qffLqHKs_a-DGVHy4e4pqD9v8by2IEF3C-HSWVToBq0pdssykb336X_AN9spPM</recordid><startdate>199501</startdate><enddate>199501</enddate><creator>Cazzadori, Angelo</creator><creator>Perri, Giovanni Di</creator><creator>Todeschini, Giuseppe</creator><creator>Luzzati, Roberto</creator><creator>Boschiero, Luigi</creator><creator>Perona, Giuseppe</creator><creator>Concia, Ercole</creator><general>Elsevier Inc</general><general>American College of Chest Physicians</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>199501</creationdate><title>Transbronchial Biopsy in the Diagnosis of Pulmonary Infiltrates in Immunocompromised Patients</title><author>Cazzadori, Angelo ; Perri, Giovanni Di ; Todeschini, Giuseppe ; Luzzati, Roberto ; Boschiero, Luigi ; Perona, Giuseppe ; Concia, Ercole</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-520818cd86cfe8d9f5173afb09b405ce5b00e31a5264425d361edd19dfc3ad983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>AIDS/HIV</topic><topic>Biological and medical sciences</topic><topic>Biopsy, Needle - adverse effects</topic><topic>bronchoalveolar lavage</topic><topic>Bronchoalveolar Lavage Fluid</topic><topic>Bronchoscopy</topic><topic>Endoscopy</topic><topic>Female</topic><topic>HIV Infections - immunology</topic><topic>Humans</topic><topic>Immunocompromised Host</topic><topic>immunocompromised patients</topic><topic>Immunosuppressive Agents - administration & dosage</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Kidney Transplantation - immunology</topic><topic>Leukemia - immunology</topic><topic>Lung - pathology</topic><topic>Lung Diseases - diagnosis</topic><topic>Lung Neoplasms - diagnosis</topic><topic>Lymphoma - immunology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Opportunistic Infections - diagnosis</topic><topic>Retrospective Studies</topic><topic>transbronchial biopsy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cazzadori, Angelo</creatorcontrib><creatorcontrib>Perri, Giovanni Di</creatorcontrib><creatorcontrib>Todeschini, Giuseppe</creatorcontrib><creatorcontrib>Luzzati, Roberto</creatorcontrib><creatorcontrib>Boschiero, Luigi</creatorcontrib><creatorcontrib>Perona, Giuseppe</creatorcontrib><creatorcontrib>Concia, Ercole</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cazzadori, Angelo</au><au>Perri, Giovanni Di</au><au>Todeschini, Giuseppe</au><au>Luzzati, Roberto</au><au>Boschiero, Luigi</au><au>Perona, Giuseppe</au><au>Concia, Ercole</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transbronchial Biopsy in the Diagnosis of Pulmonary Infiltrates in Immunocompromised Patients</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>1995-01</date><risdate>1995</risdate><volume>107</volume><issue>1</issue><spage>101</spage><epage>106</epage><pages>101-106</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>Bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) frequently are performed in the investigation of immunocompromised patients with lung disorders. The risk-benefit ratio of TBB currently is debated, since several authors have found that the less invasive BAL may provide as much information as TBB, with the avoidance of some biopsy-related side effects. We retrospectively evaluated 157 instances of bronchoscopy carried out on 142 immunocompromised patients, with both BAL and TBB performed in every case. Immunosuppressant conditions were HIV infection (79), hematologic malignancies (36), and antirejection therapy in renal transplant recipients (27). Transbronchial biopsy provided a diagnostic yield significantly higher than that obtained by BAL in all categories investigated; diagnostic rates were 77.3% for TBB and 47.6% for BAL (p <0.001) in patients with HIV infection, 55 and 20% (p <0.001) in patients with hematologic malignancies, and 57.5 and 27.2% (p <0.001) in renal transplant recipients. Looking at the whole series, the diagnostic rates of TBB and BAL were 67.5 and 36.3%, respectively (p <0.001), with a total additional yield of 33% provided by TBB, while in only 2% of cases BAL gave rise to diagnostic information not achieved by TBB. Considering that side effects followed TBB at a negligible rate (2.5%), we believe that TBB should be routinely carried out in these patients once the diagnostic strategy has been oriented to bronchoscopy.</abstract><cop>Northbrook, IL</cop><pub>Elsevier Inc</pub><pmid>7813258</pmid><doi>10.1378/chest.107.1.101</doi><tpages>6</tpages></addata></record> |
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| subjects | Adolescent Adult Aged AIDS/HIV Biological and medical sciences Biopsy, Needle - adverse effects bronchoalveolar lavage Bronchoalveolar Lavage Fluid Bronchoscopy Endoscopy Female HIV Infections - immunology Humans Immunocompromised Host immunocompromised patients Immunosuppressive Agents - administration & dosage Investigative techniques, diagnostic techniques (general aspects) Kidney Transplantation - immunology Leukemia - immunology Lung - pathology Lung Diseases - diagnosis Lung Neoplasms - diagnosis Lymphoma - immunology Male Medical sciences Middle Aged Opportunistic Infections - diagnosis Retrospective Studies transbronchial biopsy |
| title | Transbronchial Biopsy in the Diagnosis of Pulmonary Infiltrates in Immunocompromised Patients |
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