Is Surgical Biopsy Necessary for Diagnosis of Interstitial Lung Diseases: A Retrospective Clinical Study

Aim: Interstitial lung diseases are a group of diseases which have similar radiological and clinical findings and characterized with diffuse parenchyma infiltration. Surgical lung biopsy is performed for many years due to difficulties in definitive diagnosis of the diseases. However, risk of surgery related mortality and morbidity, developments in minimal invasive and radiological examinations are led us to review the role of surgical biopsy for interstitial lung diseases. In this study the patients with suspect of interstitial lung disease were evaluated in terms of the diagnostic value and the risk of surgical lung biopsy. Material and Method: The patients who underwent surgical lung biopsies for interstitial lung diseases were evaluated in this retrospective clinical study. Forty-five consecutive patients (17 female, 28 male; aged between 20-78 years, mean age was 50.45) were referred to our clinic for histopathological diagnosis. The surgical approach was wedge resection of the suspected lung parenchyma under general anesthesia on lateral decubitus position. Surgical biopsies were done via video assisted thoracoscopic surgery in 31 patients and via thoracotomy in 14 patients. Clinical outcomes were compared according to the risks and diagnostic value of the surgical biopsies (patient’s characteristics, surgical methods, number of the specimens and change in treatment). Results: A total of 47 surgical lung biopsies were performed on 45 patients with suspected interstitial lung diseases. Definitive diagnosis was obtained in 82% (n=37) of the patients. Most common diagnosis was idiopathic interstitial pneumonia (40%; n= 18). Pathological diagnosis could not be achieved in 18% of the cases. Operation related mortality was 4.4% (n=2) and morbidity was 18% (n=8). Diagnostic value of single field lung biopsy was 77%, while the ratio was 94% in 2 fields lung biopsies (p=0.169). Morbidity was significantly higher in advanced age (mean 66.8 years) (p=0.002). The surgical procedures, VATS and thoracotomy, were compared in operation time, hospitalization, complication rates, and diagnostic value. VATS was superior in mean hospitalization (6.1 days vs.3.7 days) and operation time (75min vs. 45 min) (p=0.005). There was no difference in complication rate and diagnostic value of the surgical methods. Discussion: Surgical lung biopsy has an important role in differential diagnosis of interstitial lung diseases. Both thoracotomy and VATS are very safe and effective methods for lung biopsy because of low mortality and morbidity rates and high diagnostic value. However VATS is superior to thoracotomy with shorter hospitalization and operation time. Advanced age and need for mechanical ventilation should be considered as the major risk factors for surgical biopsy candidates.