Chest
Volume 107, Issue 1, January 1995, Pages 101-106
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Clinical Investigations: Infections: Articles
Transbronchial Biopsy in the Diagnosis of Pulmonary Infiltrates in Immunocompromised Patients

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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.

Section snippets

Study Population

At the General Hospital of Verona, 142 immunocompromised patients underwent bronchoscopy for the investigation of 157 episodes of pulmonary infiltration from 1987 to 1992. Further, 18 patients with similar conditions underwent bronchoscopy in the same study period but were not considered in the comparative evaluation here concerned, because BAL only was performed in these patients.

The study population described here is limited to patients who had an established diagnosis of an immunosuppressant

Results

The results are summarized in Table 1, and the specific pulmonary disorders diagnosed in each group of patients are listed in Table 2 together with the diagnostic yields, respectively, obtained by TBB and BAL in each disorder here encountered.

Discussion

Pulmonary infiltrates are frequently a diagnostic challenge in immunocompromised patients and invasive techniques often are used in the diagnostic process. In the present study, we evaluated the diagnostic usefulness and safety of TBB in three groups of patients with different underlying immunodeficiencies, whose pulmonary infiltrates were not etiologically recognized by simple sputum-based investigations and failed to clear with an empiric wide-spectrum antibiotic therapy. All the patients

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