Outcomes Following Surgical Lung Biopsy for Interstitial Lung Diseases: A Monocenter Experience

Abstract

Background Surgical lung biopsy (SLB) is considered in the investigation of interstitial lung diseases (ILDs) when a complete clinical evaluation and a multidisciplinary discussion (MDD) do not allow the clinician to make a confident diagnosis. Owing to the risk of the procedure, an appropriate assessment of the risk/benefit ratio prior to the intervention is recommended. We aimed to assess the postoperative outcomes and diagnostic yield of SLB for the investigation of ILD in a tertiary care institution. Methods We conducted a retrospective cohort study of consecutive subjects who underwent a SLB for the investigation of ILD in our center from 2009 to 2020. The postoperative mortality and complications rates as well as the diagnostic yield of the procedure were assessed. Results Of the 1,805 patients newly investigated for ILD in our center from 2009 to 2020, 71 (3.93%) underwent a SLB. At days 30 and 90, the mortality rates were 0 and 2.8%, whereas 4.3 and 7.6% patients experienced an acute ILD exacerbation, respectively. In addition, 4 (5.8%) patients experienced infectious complications and 5 (7.0%) presented prolonged air leaks (all within 30 days). A definite pathological diagnosis was made in 47 (66.2%) patients. Following postoperative MDD, a confident diagnosis was made in 61 patients (85.9%) and resulted in a change of therapy in 49 (69.0%) patients. Conclusion SLB for the diagnosis of unclassifiable ILDs is associated with low mortality but significant morbidity. However, it results in a confident diagnosis and a change in therapy in the majority of patients.

Assessment of a Randomized Controlled Trial on the Safety of Pre-placing Bronchial Balloons in Transbronchial Lung Cryobiopsy for Diagnosing Interstitial Lung Disease

“…Surgical lung biopsy (SLB) has long been the preferred modality for tissue sampling because, in the majority of cases, traditional transbronchial forceps biopsies provide tissue samples that do not allow for reliable pathologic diagnosis (7,8). But along with a high diagnostic rate comes the fact that SLB is associated with signi cant morbidity and mortality (9)(10)(11), especially in those patients with comorbidities or with severely impaired lung function. At the same time, not all medical centers have the capacity to perform SLB.…”