Thoracoscopic lung biopsy in diagnosis of malignancy in children

Abstract

I n t r o d u c t i o n . Advances in technology and the increasing experience of surgeons have made the thoracoscopic approach possible in diagnostic process in pediatric oncology. The objective of this paper is the retrospective analysis of efficacy and safety of thoracoscopic lung biopsy in diagnosis of malignancy in children.

M a t e r i a l  a n d  m e t h o d s . Between 2010-2012 thoracoscopy with lung biopsy was performed in 12 cases in 10 children, including 5 boys and 5 girls, aged 2-17 years.

R e s u l t s . In 11 out of 12 cases the result was conclusive. In 5 cases the lung biopsy was done due to problems with initial diagnosis, and in 7 cases due to suspicion of relapse of malignant disease. In 3 cases the diagnosis of malignancy was confirmed as: Hodgkin lymphoma, non-Hodgkin lymphoma and soft tissue sarcoma. In the group of children diagnosed due to relapse suspicion, the lung biopsy was performed 3-33 months after initial diagnosis. Results were conclusive in all 7 cases. In 3 cases malignancy was confirmed as Ewing sarcoma twice or neuroblastoma, and in 4 cases malignancy was not confirmed, including one case of diagnosis of invasive fungal infection. None of the children, who were excluded from malignant disease, experienced relapse during at least 2-year follow-up. The procedure of thoracoscopy with lung biopsy was safe. In the postoperative period only one patient required short-time Intensive Care Unit hospitalization because of respiratory insufficiency. In 5 cases only minor problems occurred including 4 cases of small subcutaneous emphysema. Median time of pleural drainage was 2 days (0-5 days). There were no periand postoperative deaths.

C o n c l u s i o n s . Thoracoscopy with lung biopsy is a safe, effective approach for the evaluation and resection of pulmonary pathologic changes. The diagnostic yield of this method is very high in children.