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Impact of skin biopsy on the management of acute graft‐versus‐host disease in a pediatric population
Author(s) -
Haimes Hilary,
Morley Keith W.,
Song Hannah,
Okhovat JeanPhillip,
Schmidt Birgitta,
Huang Jennifer T.
Publication year - 2019
Publication title -
pediatric dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 73
eISSN - 1525-1470
pISSN - 0736-8046
DOI - 10.1111/pde.13840
Subject(s) - medicine , biopsy , histopathology , skin biopsy , graft versus host disease , hematopoietic stem cell transplantation , complication , disease , retrospective cohort study , population , dermatology , surgery , transplantation , pathology , environmental health
Background/Objectives Acute graft‐versus‐host disease ( GVHD ) of the skin is a common complication of hematopoietic stem cell transplantation ( HSCT ) but often represents a diagnostic challenge. The adult literature suggests that histopathology rarely dictates management decisions, but the clinical utility of skin biopsies in pediatric patients with suspected acute GVHD is unknown. The objective of this study was to determine the frequency with which skin biopsy leads to a definitive diagnosis of acute GVHD and changes the management of acute GVHD in the pediatric population. Methods We conducted a retrospective analysis of histopathology results and the associated impact on clinical management based on chart review of pediatric patients who underwent skin biopsy for cutaneous eruptions suspicious for acute GVHD from 1995 to 2016. Results Among 27 pediatric HSCT patients, skin biopsy yielded definitive diagnoses ( GVHD or otherwise) in only 15% (4/27) of cases. Overall, dermatology consultation was associated with clinical management changes in 78% (21/27) of cases. A change in management was definitively based on skin biopsy results in only 7.4% (2/27) of cases. The mean duration of time between dermatology consultation and return of biopsy results was 4.8 days (range 1‐17). Conclusions Our results suggest that skin biopsy of pediatric HSCT patients with findings concerning for acute skin GVHD rarely yields a definitive diagnosis or change in management.