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Medical thoracoscopic lung biopsy in interstitial lung disease: a prospective study of biopsy quality
J Vansteenkiste1, E Verbeken, M Thomeer
1Dept of Pulmonary Medicine, University Hospital Gasthuisberg, Catholic University Leuven, Belgium.
Insights
Medical thoracoscopy with lung biopsy provides high-quality specimens for diagnosing interstitial lung disease (ILD). This safe procedure offers valuable diagnostic clues, aiding in the management of ILD of unknown origin.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Pathology
Background:
- Interstitial lung disease (ILD) diagnosis can be challenging.
- Conventional methods may not always yield definitive results.
- Lung biopsy is crucial for accurate ILD diagnosis.
Purpose of the Study:
- To evaluate the quality and diagnostic value of lung biopsies obtained via medical thoracoscopy.
- To assess the safety and efficacy of this procedure in diagnosing ILD.
Main Methods:
- Prospective analysis of 118 lung biopsy samples from 24 patients with ILD.
- Procedures performed during medical thoracoscopy under local anesthesia with spontaneous ventilation.
- Biopsy specimens analyzed by a pathologist blinded to clinical data.
Main Results:
- Good quality biopsies were obtained in 78% of samples.
- A definitive diagnosis or significant diagnostic clues were achieved in all patients.
- No major complications were reported; chest tube drainage correlated with ILD severity.
Conclusions:
- Lung biopsy via medical thoracoscopy is a safe and effective method for diagnosing ILD.
- Interventional pulmonary endoscopists can perform this procedure with good diagnostic yield.
- This technique aids in the etiological diagnosis of ILD of unknown origin.
Abstract:
The aim of this study was to analyse the quality and diagnostic value of lung biopsies for the diagnosis of interstitial lung disease (ILD), taken with diathermy coagulation cup forceps during medical thoracoscopy. Patients with ILD, not specified after thorough clinical assessment, high-resolution CT (HRCT), bronchoalveolar lavage and transbronchial biopsy, were studied. Medical thoracoscopy was performed in an endoscopy suite under neuroleptic anaesthesia with spontaneous ventilation. Biopsy specimens were analysed prospectively by one lung pathologist blinded to the clinical findings. Over 2 yrs, 118 samples were analysed from 24 consecutive patients. A good quality biopsy was obtained in 23 patients, and 78% of the samples were of good quality. Biopsy findings plus clinical and HRCT data revealed a relevant diagnosis in 18 patients and some diagnostic clues in four patients, for whom further examinations were needed. No major complications occurred. Chest tube drainage averaged 5.3+/-4.7 days, and was related to the total lung capacity (p=0.008), which mirrors the severity of ILD. Separate sampling of biopsies from different lobes proved to be useful in one third of the cases. In conclusion, lung biopsy sampling can be performed safely by interventional pulmonary endoscopists and has a good diagnostic yield in interstitial lung disease of unknown origin.