The role of surgical lung biopsy in the management of interstitial lung disease: experience from a single institution in the UK

Abstract

SLB is a well-recognized procedure. Although it provides a diagnosis for the majority of patients, in our series SLB was inconclusive in a considerable number of cases and did not lead to a therapeutic change for more than half of all patients. Furthermore, SLB is not without risk and can be associated with a prolonged hospital stay. We believe that SLB should be performed in a select group of patients with ILD after discussion by a multidisciplinary panel.

Surgical lung biopsy for differential diagnosis of interstitial lung disease

“…Granulomatous diseases have been reported in 5 to 16% and malignancy in 5 to 13.3% of patients. [5][6][7]18,20,21] In the published series, the diagnostic yield of SLB ranged between 34 to 98% and the most common diagnosis was reported as IPF. [19,20] In the current study, final diagnosis was reached in 80% and the most common diagnosis was UIP, which complies with the existing literature.…”

“…However, taking multiple biopsies have been suggested in the first published reports and in current guidelines. [3,4,22] In 2013, Blackhall et al [6] reported that a median of two biopsies significantly increases the probability of reaching a definitive diagnosis. On the other hand, sampling from either a single biopsy or multiple biopsies have not made a significant difference in providing a diagnosis in other reports.…”

“…Surgical lung biopsy is often discussed in terms of its diagnostic value, mortality and morbidity. [4][5][6] Even though there has been continuous practice of SLB for decades, there is still no consensus on the site and number of the surgical biopsies. Lingula and middle lobe have been reported to be common sites of inflammatory, fibrotic and vascular changes so that segments other than lingula and middle lobe are suggested to be sampled.…”

“…[9,10] Furthermore, both positive and negative results have been reported on the effect of the number of biopsies on the diagnosis rate. [6,9] Therefore, in this study, we aimed to investigate the diagnostic yield of SLB for the differential diagnosis of ILD and the factors affecting diagnosis.…”

Evaluation of patients with fibrotic interstitial lung disease: A Canadian Thoracic Society position statement

“…52 Two studies reported yields below 70%, although these outliers were limited by the lack of SLBx review in a MDD. 53,54 The yield of SLBx can be optimized through several means. 3 Biopsies should have a depth 2 cm and maximum diameter 4 cm when gently inflated post-resection.…”