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1 From the Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis
2 From the Surgical Pathology, Washington University School of Medicine, St. Louis
Marin H. Kollef, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Box 8052, 660 S. Euclid Ave, St. Louis, MO 63110; email: marin{at}wupulm3.wustl.edu
Study objective: To determine the diagnostic yield of histologic specimens obtained by postmortem transbronchial biopsy (TBB) in patients with acute respiratory failure requiring mechanical ventilation.
Design: Standard postmortem histologic examination of lung tissue specimens.
Setting: An urban university-affiliated hospital.
Patients or participants: Thirty patients with diffuse pulmonary infiltrates and acute respiratory failure, who underwent postmortem examination.
Interventions: Following removal of the lungs from the thorax. TBBs were obtained from the lower lobe of each deflated lung and comparison was made to a 1-cm3 tissue block obtained from the ipsilateral lower lobe.
Measurements and results: Standard postmortem histologic examination provided a specific diagnosis in 85% of the 60 lungs examined, and histologic evidence of acute pneumonia was present in 30% of the lungs. The overall yield of TBB was 48% for establishing a specific histologic diagnosis and 15% for the diagnosis of acute pneumonia. Using standard postmortem histologic examination as the gold standard, the sensitivity and specificity of TBB for making a specific diagnosis were 57% and 100% respectively, with corresponding positive and negative predictive values of 100% and 29%. For the histologic diagnosis of acute pneumonia, the sensitivity of TBB was 50%, the specificity was 100%, and the positive and negative predictive values were 100% and 82%, respectively. The kappa statistic for the agreement between the two diagnostic methods was 0.28 for establishing a specific diagnosis and 0.58 for the diagnosis of acute pneumonia. Obtaining 12 TBBs rather than six TBBs did not increase the diagnostic yield for TBB.
Conclusions: These findings suggest poor overall agreement between standard postmortem histologic examination and TBB specimens. Although not performed in a clinical setting, this postmortem investigation suggests that TBB may be of limited value in mechanically ventilated patients with acute respiratory failure because of its low sensitivity.
Key Words: acute respiratory failure • critical care • flexible bronchoscopy • mechanical ventilation • pneumonia • transbronchial biopsy
Submitted on September 16, 1997
Accepted on February 17, 1998
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