Aim of the study:
Lung biopsy in children is an invasive technique associated with significant morbidity. However, it offers histological evidence to aid diagnosis. The aim of this study is to determine the diagnostic accuracy of paediatric lung biopsies and to identify the preoperative factors that influence the efficacy of lung biopsy.
A retrospective review of all diagnostic lung biopsies in children from January 2007 to December 2017 was performed. Therapeutic resections were excluded. Data were collected from clinical coding, patient records, histology reports and operation notes. The indications, techniques and diagnostic accuracy for each biopsy were collated.
Thirty nine patients were available for this study. Median age at biopsy was 3.5 years (range= 7 days – 15 years). Male to Female ratio was 7:6. Open procedures were performed in 35 patients compared to 4 which were thoracoscopic (10%). Indications were suspicion for neoplasm (26%), infection (41%), interstitial lung disease (23%), abnormal infiltrative chest x-ray (10%). Lung biopsy was diagnostic in 25 (64%), inconclusive in 12 (31%) and normal parenchyma found in 2 (5%). Diagnostic accuracy (positive or negative for malignancy) was highest in the neoplastic group (90%) and lowest in the infiltrative x-ray group (50%). If preoperative investigations indicated a particular diagnosis, lung biopsy was confirmative in 77% of cases. However, if preoperative investigations were inconclusive and the biopsy was performed to aid diagnosis, the histology results in 63% of cases were inconclusive as well.
In our cohort, lung biopsy mostly confirmed the preoperative diagnosis. However, in a significant number, the diagnosis was inconclusive. It is infrequent to diagnose a new condition on lung biopsy which was not suspected preoperatively. Careful patient selection is recommended to maximise diagnostic yield.