BACKGROUND: Current guidelines for interstitial lung disease support a surgical biopsy for optimal diagnosis and treatment, yet only a minority of patients undergo such biopsy. Our objectives were to address the properties of a surgical lung biopsy for suspected interstitial lung disease, the diagnostic yield of the procedure, and whether it resulted in changes in diagnosis and treatment. METHODS: A retrospective nationwide study including 73 patients (mean age, 57.3 years; 58% males) who underwent a surgical lung biopsy for suspected interstitial disease in Iceland between 1986 and 2007 was conducted. Patient records and histologic specimens were reviewed. Before the surgical biopsy a transbronchial or computed tomography-guided biopsy had been performed in two thirds of the patients. RESULTS: The complication rate for surgical lung biopsy was 16%, and 30-day operative mortality was 2.7%, both significantly higher in patients with preoperative respiratory failure. After the procedure, a definite histopathologic diagnosis was obtained in 81% of the patients. Usual interstitial pneumonia was the most common diagnosis (31%). The clinical diagnosis was changed for 73% of the patients, and in 53% of the patients the biopsy resulted in changes in treatment. CONCLUSIONS: Surgical lung biopsy is a powerful tool for diagnosis of suspected interstitial lung disease. It results in a specific diagnosis for the majority of patients and changes in treatment for more than half. Operative morbidity and mortality are low but still significant, so patients should be carefully selected for the procedure, especially those with respiratory failure.
BACKGROUND: Current guidelines for interstitial lung disease support a surgical biopsy for optimal diagnosis and treatment, yet only a minority of patients undergo such biopsy. Our objectives were to address the properties of a surgical lung biopsy for suspected interstitial lung disease, the diagnostic yield of the procedure, and whether it resulted in changes in diagnosis and treatment. METHODS: A retrospective nationwide study including 73 patients (mean age, 57.3 years; 58% males) who underwent a surgical lung biopsy for suspected interstitial disease in Iceland between 1986 and 2007 was conducted. Patient records and histologic specimens were reviewed. Before the surgical biopsy a transbronchial or computed tomography-guided biopsy had been performed in two thirds of the patients. RESULTS: The complication rate for surgical lung biopsy was 16%, and 30-day operative mortality was 2.7%, both significantly higher in patients with preoperative respiratory failure. After the procedure, a definite histopathologic diagnosis was obtained in 81% of the patients. Usual interstitial pneumonia was the most common diagnosis (31%). The clinical diagnosis was changed for 73% of the patients, and in 53% of the patients the biopsy resulted in changes in treatment. CONCLUSIONS: Surgical lung biopsy is a powerful tool for diagnosis of suspected interstitial lung disease. It results in a specific diagnosis for the majority of patients and changes in treatment for more than half. Operative morbidity and mortality are low but still significant, so patients should be carefully selected for the procedure, especially those with respiratory failure.
Authors: Christopher J Ryerson; Tamera J Corte; Joyce S Lee; Luca Richeldi; Simon L F Walsh; Jeffrey L Myers; Jürgen Behr; Vincent Cottin; Sonye K Danoff; Kevin R Flaherty; David J Lederer; David A Lynch; Fernando J Martinez; Ganesh Raghu; William D Travis; Zarir Udwadia; Athol U Wells; Harold R Collard Journal: Am J Respir Crit Care Med Date: 2017-11-15 Impact factor: 21.405
Authors: Hulda R Jonsdottir; Ari J Arason; Ragnar Palsson; Sigridur R Franzdottir; Tomas Gudbjartsson; Helgi J Isaksson; Gunnar Gudmundsson; Thorarinn Gudjonsson; Magnus K Magnusson Journal: Lab Invest Date: 2015-09-21 Impact factor: 5.662
Authors: Scott Lieberman; James Benjamin Gleason; Mohamed Iyoob Mohamed Ilyas; Felipe Martinez; Jinesh P Mehta; Edward B Savage Journal: J Clin Diagn Res Date: 2017-03-01
Authors: Chitaru Kurihara; Brian Tolly; Andre DeWolf; Antoun Nader; Samuel Kim; David D Odell; Angela C Argento; G R Scott Budinger; Ankit Bharat Journal: Reg Anesth Pain Med Date: 2020-02-16 Impact factor: 6.288