Chest
Volume 127, Issue 5, May 2005, Pages 1600-1605
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Clinical Investigations
Outcomes and Safety of Surgical Lung Biopsy for Interstitial Lung Disease

https://doi.org/10.1378/chest.127.5.1600Get rights and content

Study objectives

To determine the safety of surgical lung biopsy (SLB) in patients with interstitial lung disease (ILD), and specifically in those with idiopathic pulmonary fibrosis (IPF).

Design

Retrospective cohort.

Setting

Tertiary care university-affiliated military medical center.

Patients

Individuals undergoing SLB for suspected ILD.

Measurements and results

We examined outcomes for subjects with a clinical diagnosis of ILD who had been designated to undergo SLB. Mortality (assessed at 30 and 90 days) following SLB represented the primary end point. Morbidity resulting from complications from SLB served as a secondary end point. The cohort included 83 patients (mean [± SD] age, 57.3 ± 14.2 years; men, 57.8%). IPF was eventually diagnosed in slightly more than half of the subjects. Overall, 30-day and 90-day mortality rates were low (4.8% and 6.0%, respectively). Subjects with IPF did well with SLB (30-day mortality rate, 7.1%) and did not face a higher risk of either death or complications relative to individuals with non-IPF forms of ILD. The only predictors of perioperative mortality were either the need for mechanical ventilation (MV) at the time of SLB or being immunosuppressed prior to undergoing SLB. Excluding persons who met either criterion yielded an overall 90-day post-SLB mortality rate of 1.5% in persons with IPF. Approximately 40% of patients in whom IPF was eventually diagnosed were initially thought to have another form of ILD.

Conclusions

Persons with IPF tolerate SLB well. Requiring MV or being immunosuppressed is associated with an increased risk for death following SLB. Safety concerns should not preclude referral for SLB in patients who are clinically suspected of having IPF.

Section snippets

Subjects

We retrospectively reviewed the records and radiographs of all patients who underwent SLB for suspected ILD at our institution between January 1996 and December 2002. We excluded from analysis all subjects < 18 years of age and those who had a history of biopsy-proven ILD. As defined by the American Thoracic Society statement on interstitial pneumonias, patients with suspected ILDs showed diffuse parenchymal infiltrates of varying degrees of inflammation or fibrosis that were not attributable

Results

During the study period, 88 patients underwent SLB. Complete data were lacking for five subjects, and these patients were excluded from further analysis. Hence, the final cohort included 83 individuals. As shown in Table 1, the mean age of the cohort was 57.3 ± 14.2 years, and slightly more than half were men. At the time of SLB, 45.8% of the subjects required supplemental oxygen therapy, and nearly one in five patients were immunocompromised. Slightly more than one quarter of SLBs (27.7%) were

Discussion

This retrospective analysis demonstrates the safety of performing SLB in patients with ILD, including those with IPF. More importantly, the diagnosis of IPF did not appear to increase the risk for either mortality or morbidity following SLB. The most important correlates of adverse outcomes were the need for MV at the time of SLB or being immunosuppressed. In the absence of either of these factors, death, as a complication of SLB, was rare, suggesting that mortality was more likely to be

ACKNOWLEDGMENT

The authors thank Steven Nathan, MD, for his helpful comments on earlier drafts of this article.

References (14)

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

This work was presented in part in abstract form at the 2003 Annual Meeting of the American College of Chest Physicians. The opinions expressed herein are not to be construed as official or as reflecting the policies of either the Department of the Army or the Department of Defense.

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