Original ArticleVATS Lung Biopsy in Suspected, Diffuse Interstitial Lung Disease Provides Diagnosis, and Alters Management Strategies
Introduction
Diffuse interstitial lung disease remains a diagnostic challenge and the aetiology is often unknown. Although high resolution computed tomographic (HRCT) scan of the chest may reduce the proportion of patient under-going surgical lung biopsy,1 surgery may still be needed to establish an accurate diagnosis, to identify potential treatable causes and to rule out other process (i.e. infection and malignancy).
In the pass, open lung biopsy has been considered the ‘gold standard’ but it remains an aggressive approach.2, 3, 4 Until the early nineties VATS lung biopsy has been reported to be a less invasive alternative method, and is as effective as the open procedure.5, 6, 7, 8, 9, 10, 11, 12, 13
However, recent report of in patients with suspected diffuse interstitial lung disease, open lung biopsy is associated with high mortality in the range of 16–20%.14 This operative risk is only acceptable if diagnosis is made and subsequent management enhanced. In this study, we review the role of VATS techniques in this group of patient to determine the morbidity, mortality and outcomes in terms of diagnosis and enhanced management.
Section snippets
Methods
All patients with suspected diagnosis of diffuse interstitial lung disease on clinical and radiological grounds were included in this study at Papworth Hospital, Cambridge, from May 1998 to August 2003.
They had either open lung or VATS biopsy procedures by a single surgeon. Their clinical case notes and post-operative histopathological reports were reviewed retrospectively. Patients were excluded from the study if the histopathological diagnosis was not consistent with diffuse interstitial lung
Results
During the 5-year period, 78 consecutive patients were referred to our department for surgical lung biopsy, despite after having extensive evaluation and high resolution computed tomographic (HRCT) scans. Seventy patients complied with the inclusion criteria of diffuse interstitial lung disease. They consisted of 57 (81.4%) male and 13 (18.6%) female. The mean age to surgery was 56-year old, ranging from 20- to 89-year old. As for the post-operative in-hospital stay, the mean was 2.8 days, and
Conclusion
VATS lung biopsy can be performed in patients suspected with diffuse interstitial lung disease with low morbidity and mortality, as well as a relatively short post-operative in-hospital stay. This study shown an improved mortality rate of 1.8% when compared to some series with mortality of around 4.7–6.4%.8, 12, 15 Apart from safety, our results also demonstrated efficacy of VATS lung biopsy in the diagnosis of interstitial lung disease. It provides sufficient material for histological
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