Original Article
VATS Lung Biopsy in Suspected, Diffuse Interstitial Lung Disease Provides Diagnosis, and Alters Management Strategies

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Abstract

Objectives.

In patients with suspected diffuse interstitial lung disease, open lung biopsy is associated with high mortality (16%). This risk is only acceptable if diagnosis is made and management enhanced. We reviewed the role of VATS techniques in this group to determine the morbidity, mortality and outcomes in terms of diagnosis and enhanced management.

Methods.

Over the period of 5 years, 78 patients with suspected diagnosis of diffuse interstitial lung disease on clinical and radiological grounds were referred to a single surgical team. The patients’ case notes and histology reports were reviewed retrospectively. Correlation was made with histopathological diagnosis.

Results.

All 78 patients had sufficient provision of material for histological analysis. Eight patients had a histological diagnosis not consistent with diffuse interstitial lung disease; in all eight patients, this significantly altered the subsequent management. Of the 70 patients with diffuse lung disease, 26 patients (37.1%) had a histological diagnosis of usual interstitial pneumonia. Thirteen patients (18.6%) had a histological diagnosis of unclassifiable diffuse lung disease despite an adequate biopsy. The remaining 31 patients (44.3%) had other positive histological diagnosis made. A difference between pre-operative clinico-radiological and final histological diagnosis sufficient to change prognosis and definitive management was made in 19 patients (27.1%). The mean and median post-operative stay was 2.8 days and 2 days, respectively. The in-hospital mortality was one patient (1.5%) due to adult respiratory distress syndrome.

Conclusions.

VATS lung biopsy can be performed in this group of patient with low mortality of 1.5%. It provides sufficient material for histological diagnosis in 100% of patients and alters the management and prognosis in a significant number of patients. We propose that the role of VATS and clinico-radiological techniques should be compared in a prospective controlled clinical trial.

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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