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Friday, July 25, 2014
Why is an open lung biopsy needed to identify BOOP ? Is this an inpatient procedure?Is it a risky procedure? What is the treatment when steroids have'nt been effective?
As mentioned in an earlier question, BOOP stands for Bronchiolitis Obliterans, Organizing Pneumonia. BOOP usually requires a lung biopsy because the clinical and radiographic changes are not specific - that is, without a tissue sample to examine closely, BOOP can be easily confused with other lung processes.
There are outpatient techniques for biopsing the lung, but these yield very small biopsies and, in most cases, do not give the pathologist enough material with which to make a diagnosis. When BOOP is suspected, most experts will recommend a larger lung biopsy, either via an open procedure or via a thoracoscopy. These latter procedures usually require a stay in the hospital, although, in many cases, this can be a few days or less. As with any invasive procedure, there are risks involved, including (but not limited to) bleeding, infection, and cardiac arrests. Thus, it is very important to discuss the potential risks and benefits of this, as well as any procedure, with the doctors who recommend and/or perform them.
Corticosteroids are the mainstay of therapy for BOOP, and when begun early are often effective. When BOOP fails to respond to corticosteroids, this usually indicates that the disease process is advanced, and in these cases BOOP often fails to respond to any therapy. Some experts have reported success using alternative agents, such as cyclosporin, methotrexate, and others, in cases where corticosteroids have been ineffective. These alternative approaches are still being evaluated, and should not be tried except under the supervision of a physician who is experienced with these drugs.
Stuart Green, MD
Assistant Professor of Medicine and Pathobiology
College of Medicine
University of Cincinnati