Mortality and risk factors for surgical lung biopsy in patients with idiopathic interstitial pneumonia

Abstract

Background: The overall safety of surgical lung biopsy in patients with idiopathic interstitial pneumonia (IIP) remains controversial. This study was performed to investigate the mortality and complication rate and identify the risk factors for surgical lung biopsy in patients with IIP. Methods: A total of 200 patients with IIP who underwent surgical lung biopsy at the Asan Medical Center, Korea, from April 1990 to August 2003, were enrolled. Complications and mortality were analyzed retrospectively. Results: (1) The mortality rate 30 days after the surgical lung biopsy was 4.3%, which was significantly higher than the control group. Biopsy performed at the time of acute exacerbation (AE) resulted in higher 30-day mortality (28.6%) compared to non-AE (3.0%; p < 0.05). AE was followed by biopsy itself in three cases. (2) Univariate analysis indicated that lower FVC, lower DL CO , and presence of AE were significant risk factors for 30-day mortality ( p < 0.05). However, multivariate analysis revealed that only AE (OR: 11.334, 95% CI: 1.727-74.365, p = 0.011) was an independent risk factor. (3) The patients with low DL CO (<50% predicted) had higher mortality and complication rate than high DL CO group. Conclusion: Our data suggested that the presence of acute exacerbation at the time of biopsy and lower DL CO were predictors of higher mortality after the surgical lung biopsy. #

Diagnostic Yield and Safety of Cryoprobe Transbronchial Lung Biopsy in Diffuse Parenchymal Lung Diseases: Systematic Review and Meta-Analysis

“…7 This is much lower than that for surgical lung biopsy (2-17%). [17][18][19][20][21][22][23] It is noteworthy that all of the studies considered in this review have excluded patients who had reduced lung function, evidence of pulmonary artery hypertension on echocardiography, hemodynamic instability, hypoxemia, or coagulopathy. Thus, the findings of safety of cryo-transbronchial lung biopsy in the present analysis do not apply to patients presenting with any of these features.…”

“…It may be associated with significant morbidity (2-20%), including prolonged air leak and prolonged hospital admission, and mortality (2-17%). [17][18][19][20][21][22][23] Transbronchial lung biopsy can also be performed using cryoprobes, termed cryo-transbronchial lung biopsy. 24 Cryotherapy works on the principle of the Joule-Thomson effect, wherein the adiabatic expansion of a compressed gas leads to rapid cooling.…”

Regulation of Collagen V Expression and Epithelial-Mesenchymal Transition by miR-185 and miR-186 during Idiopathic Pulmonary Fibrosis

“…In patients failing to demonstrate a typical IPF pattern on their chest radiographs, IPF is diagnosed on the basis of surgical lung biopsy, which is an invasive procedure with several known complications, including persistent air leak, prolonged mechanical ventilation, pneumonia, and acute exacerbation of IPF. 25,26 Furthermore, pathological diagnosis of IPF on surgical lung biopsy can be challenging as varied levels of confidence in the pathological diagnosis of IPF/UIP exist and some patients may demonstrate an unclassifiable fibrotic pattern. A reliable biomarker for diagnosis of IPF is needed.…”

Idiopathic pulmonary fibrosis

“…Для получения репрезентативных образцов легочной ткани хирур гическая биопсия легких производится из разных долей легких. Несмотря на то, что хирургическая биопсия легких считается наиболее точным методом определения гистопатологического паттерна ИЗЛ, сама процедура связана с определенным риском не желательных явлений, особенно у пациентов с тяже лыми функциональными изменениями, быстрым ухудшением состояния и при сопутствующей пато логии [65][66][67][68][69]. Таким образом, решение о проведе нии хирургической биопсии легких должно при ниматься индивидуально, с учетом клинической картины, диагностических возможностей, потенци альных преимуществ от достижения достоверного диагноза, учета риска данной процедуры и предпоч тений пациента.…”