Safety and efficacy of video-assisted thoracoscopic biopsy in patients with interstitial lung disease- a retrospective cohort study

Background:

Interstitial lung diseases (ILD) are heterogeneous and require histopathological diagnosis for prognostic and therapeutic purposes. Computed tomography and bronchoscopical tissue biopsy may lead to insufficient diagnosis and thus surgical lung biopsy may be required. Since patients with suspected ILD are at high risk for postoperative exacerbations and as literature reports high complication rates after VATS biopsies, the aim of this study was to clarify the safety and efficacy of surgical lung biopsies for ILD diagnosis at our center.

Material and method:

Patients with suspicion for ILD who underwent VATS biopsies at a single high-volume center between 2010 and 2018 were retrospectively analyzed. Clinical parameters were reviewed focusing on the incidence of complications, mortality and definitive histology.

Result:

69 Patients with suspected ILD were identified (mean age = 61.5, male n = 39). All patients were operated by VATS, in 3 cases a conversion to limited thoracotomy was necessary. Pre-operative lung function was available in 87% of patients (n = 60, mean FEV1 = 70.9%, FVC = 71.3%, DLCO 46.3%). 27 (39.1%) patients underwent a diagnostic procedure prior to the VATS with inconclusive results (bronchoscopy n = 26, EBUS n = 1). A definitive pathological diagnosis was obtained in 98.6%. The mean duration of thoracic drainage was 2.1 days and the mean length of hospital stay 6.4 days. The overall rate of postoperative complications was 5.8% (prolonged airleak n = 2, mean 17,5 days; exacerbation n = 2). In both cases with postoperative exacerbation high urgent lung transplantation was necessary. The overall 30- and 90-day mortality was 0%.

Conclusion:

This retrospective single-center study shows that VATS biopsy is a relative safe method with short duration of hospital stay, low complication rate and high rate of pathological diagnosis. Therefore, VATS biopsy can be recommended as a valuable diagnostic tool in patients with indeterminate diagnosis of ILD.