Abstract
Background: Differential diagnosis of Interstitial Lung Disease(ILD)is essential;role of VATS lung biopsy(VLB)is controversial.
Aims/Objectives: Ascertain if VLB accuracy is superior to HRCT & role in ILD management.
Methods: ILD without clear pathological diagnosis(2008–2014).
| Smoking status | |
| Never[No.(%)] | 26 (29.89%) |
| Former[No.(%)] | 42 (48.27%) |
| Current[No.(%)] | 19 (21.84%) |
| Preoperative pulmonary function tests | |
| FEV1[%,(range)] | 82.3 (57.3-101) |
| DLCO/VA[%,(range)] | 57.9 (39.9-94.2) |
Results: 87 consecutive patients included.Specific pathologic diagnosis in 97.7%. HRCT identified pathologic diagnosis in 51.7%.Major complications=3.5%[ILD acute exacerbation(1),hemothorax(1),postoperative pneumonia(1)].Minor complications=5.8%.64.4% received changes in treatment.Mortality was absent.Risk factors at Cox analysis were increasing age(p<0.05) & need for preoperative supplemental O2(p<0.0001).
| Diagnosis of ILD | Preoperative (HRCT) | Postoperative (VLB) |
| Usual interstitial pneumonia | 40 (45.97%) | 33 (37.93%) |
| Cryptogenic organizing pneumonia | 0 | 4 (4.60%) |
| Respiratory bronchiolitis-associated interstitial lung disease | 17 (19.54%) | 12 (13.80%) |
| Lung dominant connective tissue disease | 0 | 9 (10.34%) |
| Anti-neutrophil cytoplasmic autoantibody-related interstitial pneumonia | 0 | 3 (3.45%) |
| Chronic hypersensitivity pneumonitis | 0 | 8 (9.20%) |
| Pneumoconiosis | 5 (5.75%) | 11 (12.63%) |
| Chronic eosinophilic pneumonia | 0 | 2 (2.30%) |
| Pulmonary lymphangioleiomyomatosis | 1 (1.15%) | 1 (1.15%) |
| Sarcoidosis | 5 (5.75%) | 2 (2.30%) |
| Unclassifiable interstitial pneumonia | 19 (21.84%) | 2 (2.30%) |
Conclusions: VLB is safe,effective,and superior to diagnostic accuracy of HRCT;it is gold standard for ILD diagnosis.VLB patients should be selected following discussion in multidisciplinary team meeting.
- Copyright ©ERS 2015
