Lung Biopsies in Patients Referred for Allogeneic Hematopoietic Cell Transplantation: Diagnostic Accuracy, Diagnostic Yield, and Clinical Utility

BACKGROUND: Pulmonary complications after allogeneic hematopoietic cell transplantation (allo-HCT) are a significant cause of morbidity and mortality. Lung biopsy may help categorize, but its diagnostic yield in this population remains poorly defined. METHODS: We aimed to determine the accuracy (descriptive histopathological report), diagnostic yield (specific histopathologic diagnosis that plausibly explained radiologic abnormalities), complication rates, and clinical utility of lung biopsies performed in patients referred for allo-HCT at a comprehensive cancer center for pulmonary opacities. We conducted a retrospective cohort study of 76 lung biopsies (image-guided transthoracic, wedge resection, or transbronchial) performed on 70 patients referred for allo-HCT. RESULTS: Lung biopsy was accurate in 93% (n = 71/76) of procedures. The diagnostic yield was 72% (n = 55/76): malignancy (26%), organizing pneumonia (24%), and infection (16%). Lung biopsy led to a change in management in 51% of procedures (n = 39/76); effective (beneficial) in 79% of cases. Major complications occurred in 7% (n = 5/76) of procedures: four had a pneumothorax requiring chest tube drainage, and one had an intraprocedural cardiac arrest resulting in death. CONCLUSION: In this highly selected cohort of patients referred for allo-HCT, lung biopsy provided a high diagnostic yield and often altered subsequent management. Integration of biopsy into diagnostic pathways may improve care in selected patients.