Surgical lung biopsy for the diagnosis of interstitial lung disease in England: 1997–2008

Abstract

International guidelines and new targeted therapies for idiopathic pulmonary fibrosis have increased the need for accurate diagnosis of interstitial lung disease (ILD), which may lead to more surgical lung biopsies. This study aimed to assess the risk of this procedure in patients from the UK.We used Hospital Episodes Statistics data from 1997 to 2008 to assess the frequency of surgical lung biopsy for ILD in England, UK. We identified cardiothoracic surgical patients using International Classification of Diseases revision 10 codes for ILD and Office of Population Censuses and Surveys Classification of Interventions and Procedures version 4 codes for surgical lung biopsy. We excluded those with lung resections or lung cancer. We estimated in-hospital, 30-day and 90-day mortality following the procedure, and linked to cause of death using data from the UK Office of National Statistics.We identified 2820 patients with ILD undergoing surgical lung biopsy during the 12-year period. The number of biopsies increased over the time period studied. In-hospital, 30-day and 90-day mortality were 1.7%, 2.4% and 3.9%, respectively. Male sex, increasing age, increasing comorbidity and open surgery were risk factors for mortality.Surgical lung biopsy for ILD has a similar mortality to lobectomy for lung cancer, and clinicians and patients should understand the likely risks involved. @ERSpublications 30-day mortality after surgical lung biopsy for ILD is 2.4% (similar to lobectomy for lung cancer)

Lung biopsy in interstitial lung disease: balancing the risk of surgery and diagnostic uncertainty

“…Furthermore, they identified male sex, increasing age and increasing comorbidities as risk factors for mortality following open surgery. Unlike in previous studies, HUTCHINSON et al [11] were able to assess mortality at several stages, including re-admissions and late mortality. The results are generally comparable to those obtained by the same group using data from a large secondary care dataset from the USA, identifying 1.7% in-hospital mortality following elective surgical lung biopsy for ILD [12].…”

“…Practice has changed since the 1997-2008 period of the study and it is likely that the mortality with video-assisted thoracoscopic surgery is lower than with open surgery. Collectively, these limitations indicate that numbers provided by the study by HUTCHINSON et al [11] cannot be directly extrapolated to our next patient in the clinic; however, the results contribute to guidance on whether the benefit of an accurate diagnosis may outweigh the potential harm of a lung biopsy.…”

“…As emphasised by the authors [11], mortality after a surgical lung biopsy can be compared, for example, to that of lobectomy for lung cancer (2.3%) [21], a therapeutic, not diagnostic, procedure. Clinicians and patients should be aware of, and understand, the risk involved, which needs to be balanced with the benefit of making or securing a diagnosis of ILD.…”

“…The risk is low, however, in patients younger than 65 years with no significant comorbidity, who have chronic progressive disease and mild-to-moderate impairment in lung function. Nonelective lung biopsy should be considered especially carefully, as in-hospital mortality was 4.6%, compared to 1.0% for elective surgery [11]. Although not specifically evaluated in the study by HUTCHINSON et al [11], patients with suspected acute exacerbation of IPF, acute symptoms or accelerated subacute disease seem to be at higher risk of mortality, and should generally not been referred for lung biopsy (in other words, the more urgent the procedure, the higher the mortality risk).…”

“…Nonelective lung biopsy should be considered especially carefully, as in-hospital mortality was 4.6%, compared to 1.0% for elective surgery [11]. Although not specifically evaluated in the study by HUTCHINSON et al [11], patients with suspected acute exacerbation of IPF, acute symptoms or accelerated subacute disease seem to be at higher risk of mortality, and should generally not been referred for lung biopsy (in other words, the more urgent the procedure, the higher the mortality risk). Overall, a more cautious approach and a possibly lower mortality rate can be expected now that risk factors have been identified.…”