Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Original article / research
Year : 2017 | Month : March | Volume : 11 | Issue : 3 | Page : OC57 - OC59

Assessing the Safety and Clinical Impact of Thoracoscopic Lung Biopsy in Patients with Interstitial Lung Disease

Scott Lieberman, James Benjamin Gleason, Mohamed Iyoob Mohamed Ilyas, Felipe Martinez, Jinesh P Mehta, Edward B Savage

1. Fellow Physician, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Florida, USA. 2. Fellow Physician, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Florida, USA. 3. Research Fellow Physician, Department of General Surgery, Cleveland Clinic, Florida, USA., 4. Attending Physician, Department of Radiology, Cleveland Clinic, Florida, USA. 5. Attending Physician, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Florida, USA. 6. Attending Physician, Department of Cardiothoracic Surgery, Cleveland Clinic, Florida, USA.

Correspondence Address :
Dr. Scott Lieberman,
Department of Pulmonary Critical Care, 2950 Cleveland Clinic, Blvd Weston, Florida-33331, USA.
E-mail: liebers3@ccf.org

Abstract

Introduction: The clinical relevance of surgical lung biopsy in Interstitial Lung Disease (ILD) is supported in the literature. Yet most reports reflect institutional or personal bias.

Aim: To evaluate the validity of radiologic diagnosis and clinical impact of lung biopsy to help clarify which patient benefit most from biopsy.

Materials and Methods: We performed a retrospective analysis of a prospectively managed database. All patients who had a surgical lung biopsy for ILD within a period of four year (2009 to 2013) were included. Data included patient demographics, peri-operative variables and outcomes. Preoperative Computed Tomography (CT) imaging was reviewed by a thoracic radiologist blinded to the original report and pathologic information.

Results: A total of 47 patients were included. Lung tissue was obtained via a thoracoscopic approach in all but two that had mini-thoracotomy. Mean operating time was 51.1 minutes (18-123), median hospital stay was two days (1-18). Most (87.2%) of the patients were discharged within 72 hours. Thirty day mortality for elective surgery was 4.5% (2/44). Post-operative complications occurred in about one third of the patients. Complications in elective procedures included pneumothorax (10.4%), re-intubation (5.4%) and prolonged intubation (2.7%). Full concordance of radiographic diagnosis with the final diagnosis was significantly higher when reviewed by a cardiothoracic radiologist (60.5% vs. 21.3%). The preoperative clinical diagnosis was fully concordant with the final diagnosis in only 28.2% of cases. In 13.0% of patients the preoperative diagnosis was incorrect. Malignancy was the final diagnosis in two (4.3%) patients. In 51.1% of the patients, results of the biopsy did alter therapy.

Conclusion: Diagnosis of specific ILD by a cardiothoracic radiologist is more specific and accurate and will probably lead to more appropriate therapy. Elective thoracoscopic surgical lung biopsy is a safe procedure, leads to a more accurate diagnosis of ILD and impacts therapy.

Keywords

Diffuse parenchymal lung diseases, High resolution computed tomography, Video-assisted thoracoscopic surgery

How to cite this article :

Scott Lieberman, James Benjamin Gleason, Mohamed Iyoob Mohamed Ilyas, Felipe Martinez, Jinesh P Mehta, Edward B Savage. ASSESSING THE SAFETY AND CLINICAL IMPACT OF THORACOSCOPIC LUNG BIOPSY IN PATIENTS WITH INTERSTITIAL LUNG DISEASE. Journal of Clinical and Diagnostic Research [serial online] 2017 March [cited: 2017 May 25 ]; 11:OC57-OC59. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2017&month=March&volume=11&issue=3&page=OC57-OC59&id=9626

DOI and Others

DOI: 10.7860/JCDR/2017/20281.9626



Date of Submission: Mar 21, 2016
Date of Peer Review: Apr 30, 2016
Date of Acceptance: Jul 15, 2016
Date of Publishing: Mar 01, 2017


Financial OR OTHER COMPETING INTERESTS: None.

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