Video-assisted thoracoscopic lung biopsy (VTLB) is getting a position of the diagnostic methods for diffuse interstitial lung disease (DILD). In this study, we review our experience with this technique in terms of postoperative complications and diagnostic accuracy.
From January 1995 to December 2004, 50 consecutive patients were intended to undergo surgical lung biopsy for the diagnosis of DILD. Actually 46 patients (88%) underwent VTLB and 4 (12%) were needed to conversion to open lung biopsy (OLB) due to the adhesion or pulmonary injury. We retrospectively analyzed those patients.
The patients consisted of 25 men and 25 women with mean age of 58.2 years (20-77 years). The preoperative respiratory functions were %VC: 76.6 ± 21.2% (38.5-131%), %FEV1.0: 83.8 ± 22.6% (37.8-139.3%), %DLco: 65.2 ± 19.3% (30.6-101.7%), and the blood gas analyses were PaCO2: 41.4 ± 3.8 torr (33.3-52.1 torr) and PaO2: 74.9 ± 9.3 torr (53.0-97.4 torr). Mean operative time was 55 minutes for VTLB and 83 minutes for OLB. The overall mean duration of chest tube drainage was 1.3 days. There was no operative mortality. Postoperative complications were seen in 4 cases (8%). Two patients had pneumothorax, and the other two experienced the exacerbation of DILD, which were successfully treated with steroid pulse therapy. Although only one biopsy was considered inconclusive (2%), the remaining 49 patients established a final diagnosis. Histological diagnosis revealed non-specific interstitial pneumonia in 26 patients, usual interstitial pneumonia in 11, and other type of idiopathic interstitial pneumonias in the remainder.
VTLB for the diagnosis of DILD is a safe method even in patients with impaired pulmonary function, although some patients needed to conversion to OLB due to the pleural adhesion or lung injury. This study also supports the notion that patients with idiopathic interstitial pneumonias may be at risk of exacerbation of their underlying disease following VTLB.
VTLB will contribute to the safe and effective pathologic diagnosis of DILD in most cases, even if the pulmonary function is considerably impaired.
Noriyasu Usami, None.