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Videothoracoscopy-assisted surgical lung biopsy for interstitial lung diseases

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An Editorial to this article was published on 29 April 2014

Abstract

Objectives

Surgical lung biopsy (SLB) by videothoracoscopy for diffuse interstitial lung diseases is recommended for detailed diagnosis. Because substantial mortality and morbidity are associated with this procedure, its safety and diagnostic yield should be validated.

Methods

Sixty-four patients with diffuse interstitial lung disease who received SLB by videothoracoscopy between 2007 and 2013 were retrospectively analyzed for mortality, surgical complication, and diagnosis. Criteria for the procedure included patients <70-year old, who had at least 60 % vital capacity and at least 40 % diffusion capacity. Patients with radiologically definite usual interstitial pneumonia were not eligible.

Results

One conversion from the 3-port approach to thoracotomy due to bleeding occurred. Mean operation and anesthesia times were 63 and 133 min, respectively. The mean hospital stay was 6 days. Only 10 patients (16 %) received prophylactic steroid and/or elastase inhibitor administration. Neither deaths nor acute exacerbations of interstitial pneumonia occurred within 60 days after surgery. Pneumothorax occurred in four cases (6 %) after discharge, which was associated with lower % vital capacity and intraoperative steroid administration. Prolonged air leak and postoperative pneumonia were observed in 2 and 1 patients, respectively. Postoperative diagnosis was obtained in all patients. A group of connective tissue disease-related interstitial pneumonia (n = 15) and chronic hypersensitivity pneumonitis (n = 18) were the major diagnoses. Discordance between pre- and postoperative diagnoses was observed among usual interstitial pneumonia, non-specific interstitial pneumonia, and chronic hypersensitivity pneumonia.

Conclusions

Surgical lung biopsy for diffuse interstitial lung diseases is safe under appropriate inclusion criteria and provides definite diagnosis.

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Acknowledgments

The authors would like to thank the members of The Department of Diagnostic Pathology, Kyoto University Hospital (director: Prof. Hironori Haga, MD, PhD) for their histopathological diagnosis of a wide variety of diffuse interstitial lung diseases. No funding sources supporting the work exist in this study. We certify that all authors have no commercial associations that might pose a conflict of interest in connection with the submitted article, especially regarding any drugs or devices referred to in this study. Department of Respiratory Care and Sleep Control Medicine, Kyoto University Hospital, is funded by endowments from Philips-Respironics (Tokyo, Japan), Teijin Pharma (Tokyo, Japan), and Fukuda Denshi and Fukuda Lifetech Kansai (Suita City, Osaka, Japan) to Kyoto University.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Kyoto University Hospital, Shogoin-kawara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan

    Makoto Sonobe, Masaaki Sato, Toshihiko Sato, Fengshi Chen, Mitsugu Omasa, Toru Bando & Hiroshi Date

  2. Department of Respiratory Medicine, Kyoto University Hospital, Shogoin-kawara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan

    Tomohiro Handa & Michiaki Mishima

  3. Department of Respiratory Care and Sleep Control Medicine, Kyoto University Hospital, Shogoin-kawara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan

    Kiminobu Tanizawa

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  1. Makoto Sonobe
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  2. Tomohiro Handa
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  3. Kiminobu Tanizawa
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  4. Masaaki Sato
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  5. Toshihiko Sato
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  6. Fengshi Chen
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  7. Mitsugu Omasa
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  8. Toru Bando
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  9. Hiroshi Date
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  10. Michiaki Mishima
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Correspondence to Makoto Sonobe.

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Sonobe, M., Handa, T., Tanizawa, K. et al. Videothoracoscopy-assisted surgical lung biopsy for interstitial lung diseases. Gen Thorac Cardiovasc Surg 62, 376–382 (2014). https://doi.org/10.1007/s11748-014-0383-0

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  • DOI: https://doi.org/10.1007/s11748-014-0383-0

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