Chest
Volume 128, Issue 4, October 2005, Pages 2375-2380
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Clinical Investigations
Thoracoscopic Lung Biopsy Is a Safe Procedure in Diagnosing Usual Interstitial Pneumonia

https://doi.org/10.1378/chest.128.4.2375Get rights and content

Objectives

To evaluate the effect of lung biopsy on the survival of patients when histopathologic confirmation of usual interstitial pneumonia (UIP) is needed.

Background

Idiopathic pulmonary fibrosis is a distinct clinical entity with histopathologic features of UIP. Surgical biopsy is needed when clinical and radiologic findings are not typical. The safety of lung biopsy is a matter of debate, and the results of short-term mortality (< 30 days) after biopsy are variable.

Methods

Seventy-six patients with UIP, including 34 patients who underwent video-assisted thoracoscopic surgery (VATS) biopsy and 42 patients who underwent open-lung biopsy, were included in this retrospective study. All biopsies were reevaluated for UIP histopathology. Clinical data such as age at the time of biopsy, type of biopsy, preoperative pulmonary function, major postoperative complications, date and cause of death, and survival time after the biopsy were gathered. Median survival was used to compare the survival between different groups, and cumulative survival was estimated using Kaplan-Meyer method.

Results

Thoracoscopic biopsy was safe for diagnosing UIP, with no short-term mortality. In contrast, open-lung biopsy was followed by four deaths (5.3%) within 1 month after the procedure. All fatal cases were accompanied by a histopathologic pattern of diffuse alveolar damage. Age of the patient at the time of biopsy was a significant predicting factor for survival. Patients < 50 years old lived 181 months (range, 119 to 242 months), and patients > 50 years old lived 75 months (range, 55 to 95 months).

Conclusions

VATS biopsy is a safe procedure in diagnosing UIP.

Section snippets

Patients and Handling of Specimens

Histopathologically typical cases of UIP were collected from the files of the Department of Pathology, Oulu University Hospital, Oulu, Finland. Biopsies between January 1973 and December 2002 were reevaluated for UIP histopathology (R.K.W., P.P.). Open-lung biopsies were performed from January 1973 to December 1992; after that time, a thoracoscopic technique was mainly used. Altogether, 76 patients (34 women and 42 men) presenting with UIP were included. Lung biopsies were performed under

Clinical Findings and Symptoms

The study population consisted of 42 men (55.3%) and 34 women (44.7%), with a mean age at the time of biopsy of 56.7 years (range, 21 to 77 years). The mean age of the women was 54.7 years (range, 21 to 74 years), and the mean age of the men was 58.3 years (range, 34 to 77 years). A total of 42 patients (55.3%) underwent open-lung biopsy, and 34 patients (44.7%) underwent thoracoscopic procedures. There were 17 current (22.4%) and 23 former smokers (30.3%) with an average smoking history of

Discussion

The short-term postoperative mortality (< 30 days) in our study was 5.3%, which was considerably lower than that in another study8 of UIP (21.7%), considering the idiopathic type of the disease. In the present study, all four patients who died within 1 month after the operation had undergone open thoracotomy. In patients who underwent thoracoscopy, the preoperative and postoperative mortalities were nonexistent, and also the morbidity was low. Therefore, the thoracoscopic operation can be

Acknowledgment

We thank Dr. Risto Pokela and Dr. Martti Mosorin for their comments on thoracic surgery and VATS. We also thank Mr. Manu Tuovinen and Ms. Päivi Koukkula for technical assistance.

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    Supported by The Finnish Anti-Tuberculosis Association Foundation, Juselius Foundation, Maud Kuistila Foundation and Fundings from Oulu and Helsinki University Hospitals.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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