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Diffuse Lung Disease |

Surgical Biopsy for Diagnosis of Interstitial Lung Disease Is Superior to High Resolution CT Imaging

Michael Kayatta*, MD; Josh Hammel, MD; Gerald Staton, MD; Srihari Veeraraghavan, MD; Felix Fernandez, MD; Allan Pickens, MD; Daniel Miller, MD; Seth Force, MD
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Emory University, Atlanta, GA


Chest. 2012;142(4_MeetingAbstracts):434A. doi:10.1378/chest.1385888
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Abstract

SESSION TYPE: Interesting Topics in ILD

PRESENTED ON: Tuesday, October 23, 2012 at 02:45 PM - 04:15 PM

PURPOSE: To determine the utility of thoroacoscopic (VATS) lung biopsy for diagnosing specific interstitial lung diseases (ILD) and to compare pathology results to high resolution chest computerized tomography (CT) readings.

METHODS: We reviewed the charts of all of the patients who received VATS lung biopsies for ILD over the past 8 years at our institution. Demographics, final pathology results, CT scan results and 30 day survival were collected. Concordance rates of CT scan diagnoses with the final diagnosis were calculated, as was the concordance rate between each patient’s individual biopsy results.

RESULTS: One hundred and ninety-four patients underwent VATS lung biopsy. The mortality was 6.7% (13/194). The major risk factors for death were oxygen supplementation, ventilator requirement preoperatively, and final diagnosis of diffuse alveolar damage (p < 0.0001, p< 0.0001, and p = 0.007, respectively). Among those on the ventilator preoperatively, the risk of death was 100% versus 4.8% of those not on the ventilator. Age (mean 64.9 among deaths, 57.5 among survivors, p = 0.06) and male sex (p = 0.06) approached significantly higher risk of death. Eighty patients were found to have usual interstitial pneumonia and 30 patients were diagnosed with other inflammatory ILDs (non-specific interstitial pneumonia, desquamative interstitial pneumonia, etc). Concordance of radiological diagnosis with the final diagnosis was extremely poor, with radiographic diagnosis matching pathologic diagnosis 15% of the time. The final diagnosis was included in the radiographic differential only 34% of the time. Performance of two biopsies versus three was diagnostic 96% of the time, and did not differ significantly based on final diagnosis.

CONCLUSIONS: VATS wedge biopsy remains the gold standard for the diagnosis of interstitial lung disease due to the inability of high resolution CT imaging to provide a definitive diagnosis in the majority of patients. VATS is a safe procedure with low mortality rates in patients who are non-ventilator dependent preoperatively. Additionally, two biopsies appear to be sufficient in diagnosing the type of ILD in the vast majority of patients.

CLINICAL IMPLICATIONS: Our study reinforces the importance of VATS lung biopsy as a safe and accurate method for obtaining a definitive diagnosis in patients with ILD

DISCLOSURE: Allan Pickens: Consultant fee, speaker bureau, advisory committee, etc.: Etihicon Corp, Educational Speaker

Daniel Miller: Consultant fee, speaker bureau, advisory committee, etc.: Ethicon Corp, Neomed Educational Advisor

The following authors have nothing to disclose: Michael Kayatta, Josh Hammel, Gerald Staton, Srihari Veeraraghavan, Felix Fernandez, Seth Force

No Product/Research Disclosure Information

Emory University, Atlanta, GA

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