Interstitial Lung Disease Diagnosis: Safety, Utility of Surgical Lung Biopsy

Surgical lung biopsies (SLBs) that are performed via video-assisted thoracic surgery (VATS) are safe for obtaining histopathologic tissue for select patients, and such biopsies provide clinicians with valuable diagnostic information concerning patients with interstitial lung disease (ILD), according to study results presented at the American Thoracic Society (ATS) International Conference, held virtually from May 14 to May 19, 2021.

The diagnosis of ILD is dependent on the interpretation of radiographic, clinical, and histopathologic data examined in a multidisciplinary setting. Surgical lung biopsy remains the gold standard for obtaining histopathologic tissue. Although SLB may be safe for select patients, prior research has suggested significant associations between SLB and morbidity and mortality.

Study investigators reviewed the records of patients at a tertiary referral center in Canada from 2002 to 2020 for SLB cases that were completed for an ILD diagnosis to assess the safety, utility, and morbidity among these patients (N=269). Physiologic, clinical, and perioperative data were collected, and postoperative complications were recorded, including acute exacerbation of ILD (AE-ILD) and mortality.

Of the 269 cases identified (53% men; mean age, 60 years), the preoperative pulmonary function tests showed a mean forced vital capacity (FVC) of 70% predicted and a diffusing capacity of the lungs for carbon monoxide (DLCO) of 47% predicted. The median modified Medical Research Council scale (mMRC scale) was 2. As for the surgical approach, 66% (n=162) of cases underwent a VATS biopsy, of which 12% (n=30) were performed as nonelective at in-patient settings, with a mean hospital stay of 4.5 days.

A total of 25% of patients (n=68) experienced postoperative complications, and 72% of these were at grade 1 or 2, according to the Thoracic Morbidity and Mortality scoring system. Acute exacerbation-ILDs occurred in 4.3% of patients (n=11), and 30- and 90-day mortality rates were 2% and 4%, respectively. History of congestive heart failure, a higher mMRC score, male sex, and presence of a definite and probable usual interstitial pneumonia radiographic pattern were associated with 90-day mortality.

Nonelective surgery was associated with significantly worse 30-day mortality (15% vs 0.5%; P =.001), 90-day mortality (19% vs 3%; P =.003), and complications of grade 3 or higher (56% vs 20%; P =.009). The most common postbiopsy diagnoses were idiopathic pulmonary fibrosis (34%), hypersensitivity pneumonitis (10%), sarcoidosis (9%), cryptogenic organizing pneumonia (8%), and connective tissue disease-associated ILD (7%). In 76% (n=187) of cases, the histopathologic diagnosis either changed the preoperative diagnosis or provided confirmation in uncertain cases.

Study investigators concluded, “Surgical lung biopsy via VATS for carefully selected ILD patients is safe. Obtaining histopathologic tissue via SLB provides valuable diagnostic information which influences clinical diagnosis and subsequent patient management.”

Reference

Yoo D, Wongkarnjana A, Agzarian J, et al. Safety of surgical lung biopsy for diagnosis of interstitial lung diseases. Presented at: the American Thoracic Society (ATS) International Conference 2021; May 14-19, 2021. Abstract A1818.