The efficacy of video-assisted thoracoscopic surgery lung biopsies in patients with interstitial lung disease: a retrospective study of 66 patients

Abstract

BackgroundDiagnosing a specific type of Interstitial Lung Disease (ILD) is a challenging process and often necessitates that a Video-assisted Thoracoscopic Surgery (VATS) Lung Biopsy be performed. By analysing the proportion of patients who have their treatment changed after undergoing a VATS lung biopsy, this study aimed to determine the utility of performing this procedure in patients with ILD.MethodsThe clinical data from sixty-six patients with suspected ILD, who underwent VATS lung biopsies at the New Royal Infirmary of Edinburgh (NRIE) in the period of 16th May 2011 – 11th February 2013, were analysed retrospectively. The main outcome measures considered in this study were: CT scan differential diagnoses, VATS lung biopsy histological differential diagnoses, post-VATS lung biopsy consensus diagnoses, 30-day mortality, surgical complications (minor and major), resultant changes in treatment and responses to these changes in treatment.ResultsFollowing VATS biopsy a definite pathological diagnosis was made in 74.2% of cases. A change in treatment was initiated in 47.2% of patients, including in 80% of patients diagnosed with Hypersensitivity Pneumonitis and 60% of patients diagnosed with sarcoidosis. A positive response to treatment was experienced in 58% of patients whom underwent a change in treatment. Only 54% of patients who received a consensus diagnosis of UIP after VATS lung biopsy, had been given a differential diagnosis of “probable UIP” at CT scan. 15% of patients who received a differential diagnosis of “probable UIP” at CT scan, had their diagnosis changed to Hypersensitivity Pneumonitis after lung biopsy. There was one mortality (1.5%) in this series of patients and no other major complications. Minor complications to surgery were experienced in 28.8% of patients.ConclusionsThis study highlights the effectiveness of performing VATS lung biopsies in patients with suspected ILD. The procedure leads to a change in treatment in almost half of all patients, including in the vast majority of cases of Hypersensitivity Pneumonitis. It also prevents what would be the inappropriate over-treatment of UIP. It has been shown to be a relatively safe procedure and thus, should be performed in all patients with suspected ILD, indeterminate in type from prior CT imaging.

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

“…Our overall figure of 2.4% 30-day mortality is similar to that reported by CARRILLO et al [21] in the next largest series, of 722 patients in Mexico from 1986 to 1990, and also SIGURDSSON et al [20] in a smaller nationwide series from Iceland from 1986 to 2007. It is slightly higher than the 2.1% estimate for VATS procedures from a systematic review by NGUYEN and MEYER [7] and the 1.5% estimate from a recent case series in Edinburgh, UK [4], but lower than a previous summary estimate reported by KREIDER et al [6] (4.5%) (although this included studies with varying mortality end-points). Although comparison of mortality figures depends on case mix, end-points and procedure types, this consistency supports our estimates, and the comparison to mortality post-lobectomy is not insignificant [16].…”

“…Case series have reported 30-day mortality rates of around 1.5-4.5%, although these may be biased by careful case selection or local expertise and are not necessarily generalisable to other centres [4][5][6][7]. Other case series note much higher mortality rates [8,9].…”

Diagnostic yield and postoperative mortality associated with surgical lung biopsy for evaluation of interstitial lung diseases: A systematic review and meta-analysis

“…6,[21][22][23][24][25] Moreover, 8 studies evaluated the frequency in which the biopsy changed the treatment algorithm, ranging from 42% to 90%. 7,8,10,15,18,20,22,24 The change was driven by specific diagnosis in 6 studies 8,15,18,20,22,24 and was not necessarily related to specific diagnosis in 2 studies. 7,10 A total of 17 studies reported biopsy sites; 11 studies were guided by computed tomography without special preference.…”

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

“…This study based on epidemiologic data adds to previous accumulating evidence from case series [13][14][15][16][17][18] indicating that the risk of surgical lung biopsy is clinically significant, even if it is lower than that in older series with probably less careful selection of cases [19,20]. 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.…”