The Role of Surgical Lung Biopsy in Diagnosis and Treatment Guidance for Interstitial Lung Diseases: A Single-Center Retrospective Study

Purpose: Interstitial lung disease encompasses a heterogeneous group of disorders requiring subgroup-specific treatment strategies. Surgical lung biopsy is recommended in patients who remain diagnostically unclassified despite clinical and radiological evaluation. This study aimed to evaluate the diagnostic yield, postoperative outcomes, and therapeutic impact of surgical lung biopsy in patients with interstitial lung disease. Methods: Cases of surgical biopsy performed for interstitial lung disease between 2018 and 2023 were retrospectively analyzed. All patients underwent a comprehensive preoperative evaluation, including HRCT, pulmonary function testing with DLCO analysis, bronchoscopy, and multidisciplinary assessment, before surgical biopsy was considered for diagnostically unclassified cases. Postoperative complications, mortality rates, definitive diagnoses, and treatments were evaluated. Results: A total of 253 patients were included in the study, comprising 150 males (59.3%) and 103 females (40.7%). The mean age was 58.4 ± 12.5 years. Minor complications were observed in 14 cases (5.5%), most commonly prolonged air leakage, while major complications occurred in 7 cases (2.8%), including hemorrhage requiring revision surgery and postoperative respiratory failure. Mortality was reported in two cases (0.8%). Comparison between surgical approaches demonstrated statistically significant differences regarding postoperative complication rates and drainage duration (p = 0.008, p < 0.001). All patients who received a definitive diagnosis were initiated on disease-specific treatments. Medical treatment was initiated for 197 cases (77.8%). Specific treatment was started for 174 cases (68.8%) following the determination of an interstitial subgroup diagnosis. Conclusion: Surgical lung biopsy performed via VATS is a safe procedure that provides significant diagnostic and therapeutic benefit in patients with interstitial lung disease, particularly in diagnostically unclassified cases despite multidisciplinary evaluation.