Role of flexible bronchoscopy in the diagnosis of pulmonary infiltrates in pediatric patients with cancer

We reviewed 60 consecutive flexible bronchoscopies done during a 36-month period in 48 pediatric cancer patients with undlagnosed pulmonary infiltrates. Diagnostic procedures during bronchoscopy included 40 brushings, 50 bronchoalveolar lavages, and 6 transbronchial and mucosal blopsies. A total of 16 specific diagnoses were made by bronchoscopy (27% diagnostic yield), including infection (12), pulmonary leukemia (3), and lymphoma (1). The largest proportion of specific diagnoses came from lavage (14/50) and the smallest from brushings (1/40). Biopsies were also useful for selected patients. The low overall yield for bronchoscopy was probably due to the routine use of empiric broad-spectrum antibiotics and antifungal therapy, as well as trimethoprim-sulfamethoxazole prophylaxis for Pneumocystic carinli pneumonitis. Subsequent specific diagnoses were obtained by other procedures (open blopsy, needle aspiration, or autopsy) for 10 patients with negative bronchoscopy results and 3 patients with dlagnostic bronchoscoples. These additional diagnoses included 7 infections ( Pneumocystis carinll (1), Candida tropicalis (1), cytomegalovirus (1), and Aspergillus (4)), and 6 other diagnoses with nonspecific histologic findings. A positive bronchoscopy result may be useful, but negative bronchoscopy findings do not justify delaying other diagnostic procedures or discontinuing antibiotic and antifungal therapy in children with cancer and pulmonary infiltrates.