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Clinical Investigations: SURGERY |

Outcomes and Safety of Surgical Lung Biopsy for Interstitial Lung Disease*

Christopher J. Lettieri, MD; Ganesh R. Veerappan, MD; Donald L. Helman, MD; Charles R. Mulligan, MD, FCCP; Andrew F. Shorr, MD, MPH, FCCP
Author and Funding Information

*From the Pulmonary and Critical Care Medicine Service (Drs. Lettieri, Veerappan, Helman, and Shorr) and the Cardiothoracic Surgery Service (Dr. Mulligan), Walter Reed Army Medical Center, Washington, DC.

Correspondence to: Christopher J. Lettieri, MD, Pulmonary and Critical Care Medicine, Walter Reed Army Medical Center, 6900 Georgia Ave, NW, Washington, DC 20307; e-mail: Christopher.lettieri@na.amedd.army.mil



Chest. 2005;127(5):1600-1605. doi:10.1378/chest.127.5.1600
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Study objectives: To determine the safety of surgical lung biopsy (SLB) in patients with interstitial lung disease (ILD), and specifically in those with idiopathic pulmonary fibrosis (IPF).

Design: Retrospective cohort.

Setting: Tertiary care university-affiliated military medical center.

Patients: Individuals undergoing SLB for suspected ILD.

Measurements and results: We examined outcomes for subjects with a clinical diagnosis of ILD who had been designated to undergo SLB. Mortality (assessed at 30 and 90 days) following SLB represented the primary end point. Morbidity resulting from complications from SLB served as a secondary end point. The cohort included 83 patients (mean [± SD] age, 57.3 ± 14.2 years; men, 57.8%). IPF was eventually diagnosed in slightly more than half of the subjects. Overall, 30-day and 90-day mortality rates were low (4.8% and 6.0%, respectively). Subjects with IPF did well with SLB (30-day mortality rate, 7.1%) and did not face a higher risk of either death or complications relative to individuals with non-IPF forms of ILD. The only predictors of perioperative mortality were either the need for mechanical ventilation (MV) at the time of SLB or being immunosuppressed prior to undergoing SLB. Excluding persons who met either criterion yielded an overall 90-day post-SLB mortality rate of 1.5% in persons with IPF. Approximately 40% of patients in whom IPF was eventually diagnosed were initially thought to have another form of ILD.

Conclusions: Persons with IPF tolerate SLB well. Requiring MV or being immunosuppressed is associated with an increased risk for death following SLB. Safety concerns should not preclude referral for SLB in patients who are clinically suspected of having IPF.

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