Diagnostic utility of surgical lung biopsies in elderly patients with interstitial lung diseases

Abstract

Background: Idiopathic pulmonary fibrosis (IPF) is increasingly diagnosed by clinical and radiographic criteria; however, surgical lung biopsy (SLB) may still be required in patients who lack definite radiologic features of usual interstitial pneumonia (UIP). Given that both the incidence of UIP and the morbidity of SLB increase with age, the clinical benefit of SLB requires careful consideration in the elderly. We reviewed a cohort of patients aged 75 years or older who underwent SLB, to evaluate the benefit of SLB in diagnosing interstitial lung disease (ILD).

Methods. We searched the pathology records of Mayo Clinic in Minnesota and Arizona for ambulatory patients at least 75 years old, who underwent SLB between 2000-2012 for indeterminate ILD. Histologic slides were retrieved and reviewed and clinical data were extracted from the record. The study was approved by the Mayo Clinic IRB.

Results. 64 patients (43 male) were enrolled. Median (interquartile range) age was 78 (76-80) years. 18 patients had a history of esophageal reflux, 12 had medication exposures (10 to statins and 1 each to amiodarone and methotrexate). 34 patients smoked with a cumulative exposure of 28 (15-40) pack-years. FVC was 72 (64-81)% and DLCO was 50 (45-57)% of predicted. 26 biopsies sampled both the upper and lower lobes, while 14 and 22 biopsies were restricted to the upper and lower lobes, respectively.

Conclusion. SLB lead to a diagnosis of UIP in 64% of elderly patients with indeterminate ILD, and changed the diagnosis in 69% of cases. SLB may guide clinical management in select elderly patients with indeterminate ILD.