Thoracoscopic lung biopsy under regional anesthesia for interstitial lung disease

Abstract

BackgroundInterstitial lung disease (ILD) management guidelines support lung biopsy-guided therapy. However, the high mortality associated with thoracoscopic lung biopsy using general anesthesia (GA) in patients with ILD has deterred physicians from offering this procedure and adopt a diagnostic approach based on high-resolution CT. Here we report that thoracoscopy under regional anesthesia could be a safer alternative for lung biopsy and effectively guide ILD treatment.MethodsThis was a single-center retrospective review of prospectively maintained database and consisted of patients who underwent thoracoscopic lung biopsy between March 2016 and March 2018. Patients were divided into two groups: (A) GA, and (B) regional anesthesia using monitored anesthesia care (MAC) and thoracic epidural anesthesia (TEA).ResultsDuring the study period, 44 patients underwent thoracoscopic lung biopsy. Of these, 15 underwent MAC/TEA. There were no significant differences between the two groups with regard to pulmonary function test and clinicodemographic profile. However, operative time and hospital stay were shorter in MAC/TEA group (32.5±18.5 min vs 50.8±18.4; p=0.004, 1.0±1.3 days vs 10.0±34.7 days; p<0.001, respectively). Eight patients in the GA group, but none in the MAC/TEA group, experienced worsening of ILD after lung biopsy (p=0.03). Additionally, one patient in the GA group died due to acute ILD worsening. No cases of MAC/TEA group had to be converted to GA. In all cases a pathological diagnosis could be made.ConclusionsThoracoscopy using regional anesthesia might be a safer alternative to lung biopsy in patients with ILD.

Surgical Lung Biopsy for Interstitial Lung Disease: A Two Center Propensity Score Matching Analysis

“…The short-term surgical outcome in our study strongly favors NIVATS-SLB with shorter procedure duration and reduced length of stay as well as decreased chest tube indwelling time and reduced total chest tube effusion. This is in line with most other case series and comparative studies [18,29].…”

“…Its incidence after GAVATS-SLB ranges from 1.05% to 7.40% [6] and usually proves to be fatal [14, 17]. Initial NIVATS-SLB series reported an AE-ILD rate of 0% [18, 19]. Our PSM revealed a 2.5% rate for AE-ILD in both groups, with one fatal outcome 60 days after NIVATS-SLB.…”

“…Perioperative morbidity -including prolonged air leak, pleural effusion, pulmonary infection, fever, and others -for ILD patients undergoing GAVATS-SLB ranges between 5.8% and 19.1%, with mortality rates between 1.4% and 6.4% [17,18,[24][25][26][27]. In NIVATS-SLB, morbidity ranges between 7.1% and 9%, with no intra- hospital mortality, although no 60 or 90 days data were presented so far [28,29].…”

Diagnostik interstitieller Lungenerkrankungen – Handlungsempfehlung mit Fokus auf rheumatologische Systemerkrankungen

“…B. bei der IPF mit einer relevanten prozeduralen Mortalität behaftet. Neuere Techniken wie die videoassistierte Thorakoskopie in Spontanatmung und Sedierung sind unter Evaluation 20 .…”

“…B. bei der IPF mit einer relevanten prozeduralen Mortalität behaftet. Neuere Techniken wie die videoassistierte Thorakoskopie in Spontanatmung und Sedierung sind unter Evaluation[20].Pathologische Befunde in der BALEine lymphozytäre Alveolitis spricht für eine erhöhte inflammatorische Aktivität (Lymphozyten > 12 %) und findet sich insbesondere bei der Sarkoidose und der EAA (Lymphozyten > 40 %), aber auch bei systemischen Auto-Immunerkrankungen und viralen Infektionen (Lymphozyten 20-40 %). Eine granulozytäre Alveolitis (Granulozyten > 3 %) findet sich bei einem pulmonalen Infekt (Granulozyten > 20 %), im Kontext ILD als Hinweis für einen fibrosierenden Prozess (Granulozyten 5-20 %), wie bei IPF oder chronischer fibrosierender EAA.…”