Abstract
Aim: To assess and compare efficacy and safety of medical thoracoscopic lung biopsy with transbronchial lung biopsy (TBLB) for diagnosis of idiopathic interstitial pneumonias.
Material and methods: 59 patients with restriction on spirometry (Mean FVC -1.41 litres), exertional dyspnoea and interstitial pattern on HRCT (non classical for UIP) underwent lung biopsy using medical thoracoscopy.31 patients with comparable clinical profiles subjected to bronchoscopy and TBLB were used as controls.
Results: (Study group) Overall diagnostic yield was 98.3%. UIP (59.3%) was most frequent histopathological pattern.There were no intraoperative or immediate postoperative complications.Eventual complications included (in 19 patients) air leaks and prolonged ICD drainage (10), Delayed wound healing (3) and need for ventilatilatory support (5). Average duration of ICD was 4.81 days and average length of hospital stay was 6 days.There were 5 deaths within 1 month of the procedure (1 attributed to ischemic heart disease and Left ventricular failure,two to nosocomial pneumonia, two to unknown cause post discharge). Prolonged prior steroid use was single important factor associated with increased incidence of complications (14/23 complications in patients steroids vs. 5/36 complications in patients off steroids) (p<0.05).In the control group conclusive diagnosis was reached in 3/31 cases (1Sarcoidosis,1 DIP,1 BOOP). Pneumothorax needing intercostal drainage was encountered in 2 cases.
Conclusions: 1. Medical thoracoscopic Lung biopsy has higher diagnostic yield than TBLB. (98.1% vs 9.7%) (p<0.0001). 2. Prolonged prior steroid use is associated with increased incidence of complications (p<0.05).
- © 2011 ERS