Diagnostic surgical lung biopsies for suspected interstitial lung diseases: a retrospective study

Area of Science:

• Pulmonary Medicine
• Thoracic Surgery
• Diagnostic Pathology

Background:

• Current guidelines recommend surgical lung biopsy for interstitial lung disease (ILD) diagnosis and treatment.
• However, only a minority of ILD patients undergo this procedure.
• This study evaluates the properties, diagnostic yield, and impact on treatment of surgical lung biopsy for suspected ILD.

Purpose of the Study:

• To assess the diagnostic yield of surgical lung biopsy in suspected interstitial lung disease.
• To determine if the procedure leads to changes in patient diagnosis and treatment plans.
• To evaluate the properties, including complication rates, of surgical lung biopsy.

Main Methods:

• A retrospective nationwide study of 73 patients who underwent surgical lung biopsy for suspected ILD in Iceland (1986-2007).
• Review of patient records and histologic specimens.
• Analysis of prior transbronchial or CT-guided biopsy in two-thirds of patients.

Main Results:

• A definite histopathologic diagnosis was achieved in 81% of patients; usual interstitial pneumonia was most common (31%).
• The clinical diagnosis changed for 73% of patients, and treatment was altered for 53%.
• Complication rate was 16%, with 2.7% 30-day operative mortality, higher in patients with preoperative respiratory failure.

Conclusions:

• Surgical lung biopsy is a valuable diagnostic tool for suspected interstitial lung disease, yielding specific diagnoses for most patients.
• The procedure significantly impacts treatment decisions for over half of patients.
• While morbidity and mortality are low, careful patient selection is essential, particularly for those with respiratory failure.