Robert E McCabe, M.D.;[unkeyable] R...

Robert E McCabe, M.D.;[unkeyable] Robert G bear withs M.D.;[unkeyable] James R. Catterall, M.D.;[Section] and Jack s Remington, M.D.

Patients with non-Hodgkin's lymphoma (NHL) are at increased risk for pulmonary infection with opportunistic pathogens associated with diminished small room mediated immunity. Open lung biopsy (OLB) at short intervals is recommended for diagnosis of pulmonary infiltrates in patients with NHL yet its usefulness for patient management and consequence has not been evaluated for patients with NHL We reviewed the issues of 20 consecutive OLB in 19 patients with previously diagnosed non-Hodgkin's lymphoma at Stanford University Medical Center during a nine-year period. Fifteen patients had known active lymphoma at time of OLB and no patient had granulocytopenia. Ten of the 20 OLB yielded specific diagnoses. A greater proportion of patients with stage I or II disease had specific diagnoses than patients with more advanced NHL Five of 14 patients considered to have had a life threatening illness at the time of OLB had specific diagnoses from OLB v five of six patients considered clinically stable. Chest roentgenograms that had discrete masses or nodules correlated with ability to establish a specific diagnosis at OLB. For patients in whom the follows of OLB were nonspecific, management appeared unaffected by the agency of the OLB. The OLB in NHL appeared greatest in quantity useful for detecting recurrent NHL in clinically stable patients with discrete nodules or masses forward chest roentgenogram. Pneumocystis pneumonia was the barely infection identified by OLB.

The character of OLB in management of patients with specific underlying disease and pulmonary lesions has not been adequately evaluated. OLB can be performed safely and, in a certain medical centers, expeditiously, and should yield an adequate sample of tissue from diseased lung as determined according to visual inspection. An unequivocal diagnosis established according to OLB permits specific treatment, discontinuation of potentially toxic treatments, and clarification of confusing clinical situations.[1,2] OLB however, does entail a risk and expense, may not terminate in improved survival, and information obtained from OLB may not be clinically useful.[3,4] unfolding of sensitive, new diagnostic techniques of that kind as bronchoalveolar lavage may obviate the ne for OLB in certain patient populations.[5,6] We reviewed our experience with OLB in patients with known NHL at Stanford University Medical Center to determine the diagnostic yield and utility of OLB for this particular clump of patients.

METHODS

Patients with non-Hodgkin's lymphoma were identified by way of review of records of the Department of Pathology at Stanford University Medical Center for the period April 1974 between the sides of December 1982. Patients were included if a lung biopsy by the agency of open thoracotomy was performed to diagnose a lung lesion and if the patient was known to have NHL before OLB

The chart of each patient was reviewed completely nevertheless particular attention was directed to stage of disease, continuance of symptoms before OLB, gravity of illness, heat neutropenia, antimicrobial therapy directed at the presum etiology of the lung lesions before and after OLB diagnostic courses other than OLB such as fiberoptic bronchoscopy transtracheal aspiration, and serologic examples roentgenographic appearance of the lesion, survival of the patient for the hospitalization during which OLB was performed, and histology and agriculture results of the OLB specimen.

The stamp of thoracotomy and site of biopsy were chosen from the thoracic surgery team. The biopsy was obtained from lung that was determined to be abnormal at time of surgery in succession the day of biopsy, touch preparations of the biopsy specimen stained with methenamine silver and routine stains of frozen sections were prepared; other stains, of the like kind as stains for Mycobacteria, were performed if considered indicated upon clinical grounds. Results of examination of the touch preparations were available within four to six hours of the biopsy manner of proceeding Hematoxylin and eosin stains, Gram stains, acid-fast stains for Mycobacteria, and stains for fungi were performed routinely, and terminates were available within two days. Portions of the specimen were cultur routinely for aerobic and anaerobic bacteria, mycobacteria, fungi, and viruses. Dieterle silver or other studies for detection of Legionella were not performed routinely during the period masked by this review.

Findings from histologic examination of lung biopsy specimens were considered either specific or nonspecific. A specific diagnosis identified a definite etiology for the pathologic proces in the lung eg infectious agents, neoplasia, and pulmonary infarction appropriate to bland thrombi. A nonspecific diagnosis did not identify a definite etiology. This category included organizing pneumonia, bronchiolitis obliterans, interstitial pneumonitis, and fibrosis.

Lymphoma was considered active when the patient was receiving either radiation therapy or chemotherapy for their lymphoma; lymphoma was considered inactive when the patient was not receiving as it was treatment and had no evidence of residual lymphoma.