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Is There Still a Place for Transbronchial Lung Biopsy or Other Lung Biopsy Techniques?

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Pulmonary Involvement in Patients with Hematological Malignancies

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Abstract

A prompt diagnosis is crucial to improving survival in immunocompromised patients with pulmonary infiltrates. Early noninvasive tests should be performed, with or without invasive tests. In patients with hematological malignancies who are scheduled for bronchoscopy with bronchoalveolar lavage (BAL), transbronchial biopsy (TBB) may provide additional information in up to 30% of cases. The diagnostic yield of TBB ranges from 26% to 68% in published studies. TBB is not performed routinely in immunocompromised patients, due to safety issues and to uncertainty about the clinical relevance of TBB findings in some situations. In non-neutropenic patients scheduled for diagnostic bronchoscopy, TBB should be combined with BAL in the initial diagnostic workup if noninfectious causes of lung infiltrates are suspected. This may avoid sequential procedures, but requires the absence of contraindications to TBB. In neutropenic patients scheduled for bronchoscopy, TBB should not be performed. Surgical lung biopsy is more invasive than BAL with TBB. In patients receiving mechanical ventilation, the expected benefit from biopsies needs to be carefully discussed, as the diagnostic yield and survival gain are questionable.

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Authors and Affiliations

  1. University Hospitals Leuven, 49, Herestraat, 3000, Leuven, Belgium

    Christophe Dooms

  2. C.H.U. St Pierre – Clinique de Pneumologie, Saint-Pierre University Hospital Brussels, 322, rue Haute, 1000, Brussels, Belgium

    Vincent Ninane

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  1. Christophe Dooms
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  2. Vincent Ninane
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Correspondence to Vincent Ninane .

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Editors and Affiliations

  1. Service de Réanimation Médicale, Hôpital Saint Louis, Avenue Claude Vellefaux 1, Paris, 75010, France

    Elie Azoulay

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Dooms, C., Ninane, V. (2011). Is There Still a Place for Transbronchial Lung Biopsy or Other Lung Biopsy Techniques?. In: Azoulay, E. (eds) Pulmonary Involvement in Patients with Hematological Malignancies. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-15742-4_13

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  • DOI: https://doi.org/10.1007/978-3-642-15742-4_13

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  • Print ISBN: 978-3-642-15741-7

  • Online ISBN: 978-3-642-15742-4

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