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.

Keywords

surgical lung biopsy - interstitial lung disease - pulmonary fibrosis - acute exacerbation - multidisciplinary discussion

Authors' Contributions

E.M., E.O., J.M., M.F., S.M., L.B., M.C., S.P., and G.D. made substantial contributions to the conception of the study and the interpretation of data.

E.O. and E.M. contributed to the acquisition of data.

E.M. drafted the initial work, which was critically revised for important intellectual content by J.M., M.F., S.M., M.C., E.O., S.P., and G.D., and supervised mostly and equally by S.P. and G.D.

E.M., E.O., J.M., M.F., S.M., L.B., M.C., S.P., and G.D. approved the final version of the manuscript.

E.M., E.O., J.M., M.F., S.M., L.B., M.C., S.P., and G.D. agree to be accountable for all aspects of the work.

^* Both the authors contributed equally to the study.

^¶ Both the authors equally supervised the study.

Publication History

Received: 14 August 2021

Accepted: 02 November 2021

Article published online:
12 February 2022

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