Controversy exists regarding the role of surgical lung biopsy (SLB) in suspected idiopathic pulmonary fibrosis (IPF). The clinician’s decision to refer patients for SLB incorporates an estimate of the risk of this procedure. To better gauge the risk of SLB, we examined postoperative outcomes for patients undergoing SLB for interstitial lung disease (ILD).
We reviewed the records of patients who underwent SLB between January 1996 and December 2002 for ILD at our institution. Thirty-day postoperative mortality was the primary endpoint while 90-day postoperative mortality represented a secondary endpoint. We compared mortality among those eventually diagnosed with IPF to outcomes for patients with other ILDs. The final diagnosis of IPF required the appearance of usual interstitial pneumonia on histopathology.
During the study period, 68 patients underwent SLB (mean age 58.7±13.4 years, 63% male) and 37 (54.4%) were diagnosed with IPF. Other diagnoses included: sarcoidosis, non-specific interstitial pneumonia, and cryptogenic organizing pneumonia. Patients with IPF were older (62.5±9.4 years vs. 54.0±16.1 years, p=0.0145) and half required supplemental oxygen at time of SLB. The FVC did not differ pre-operatively based on final diagnosis (FVC in IPF 72.0±14.2% predicted vs. 69.6±13.8% predicted, p=NS). The DLCO, however, was lower in those eventually diagnosed with IPF (37.5±12.9% for IPF vs. 49.9±15.8, p=0.005) The overall 30-day mortality rate was low (1.5%). For those with IPF, the 30-day mortality rate was 2.7% and was not different from the death rate (0%) seen among those with other conditions. Cumulative 90-day mortality rates were also low (5.4% in IPF vs 0% in alternative diseases, p=NS).CONCLUSIONS: The risk for mortality following SLB in suspected IPF is low. For selected patients, having IPF does not appear to alter the safety of SLB.
Despite being older and having worse lung function than others referred for SLB, those with IPF tolerate this procedure well. Concerns about the potential risk of SLB in IPF should not routinely preclude its use in selected cases.
C.J. Lettieri, None.