Mohammed W. Khalil
Castle Hill Hospital, UK
Title: Single versus Multiple Lung Biopsies for the Diagnosis of Suspected Interstitial Lung Disease
Biography
Biography: Mohammed W. Khalil
Abstract
While some surgeons believe that one biopsy taken from the most suggestive part of the lung as shown by CT scan of the chest is enough to arrive at a histological diagnosis, others believe that multiple biopsies from different lobes (2 or 3) are less likely to result in a missed diagnosis due to inadequate or unrepresentative sample. We compared the results of the patients who had a single biopsy with those that had multiple biopsies in terms of positive yield of histological diagnosis, the length of in-hospital stay after the procedure, as well as the length of time the chest drain remained in the chest post-operatively before it was removed after cessation of post-operative air-leak.
Methods:
Data of all the patients referred by respiratory physicians and who underwent VATS lung biopsy for suspected ILD was collected retrospectively from our hospital data system and the patients were grouped into those that had a single lung biopsy (Group A) and those that had multiple lung biopsies (Group B). High resolution CT scan of the chest was reviewed for every patient prior to the procedure, and the part(s) of the lung that was most appropriate area(s) for sampling chosen, often buttressed by recommendation from the respiratory physicians. The lingula of the left upper lobe was avoided in all cases. All cases were performed through three-port VATS.
Results:
115 patients underwent VATS lung biopsy in our Department between 2009 and 2015. A single biopsy was taken from 67 patients, while 48 patients had more than one biopsy (36 patients had two biopsies while 11 had three biopsies from different lobes). Histological diagnosis was arrived at in all patients in both groups, with no incidence of inappropriate, insufficient, or normal lung tissue. There was no in-hospital or 30-day mortality reported in either group. The overall median length of post-operative hospital stay was 3 days, and the median duration of chest drainage was 1 day. There was no statistically significant difference between the two groups in terms of length of hospital stay post-operatively (p = 0.235), or in terms of the duration of chest drain post-operatively (p = 0.303).
Conclusion:
VATS lung biopsy for the diagnosis of ILD is a safe procedure and is an essential diagnostic tool in distinguishing the various types of ILD whose diagnosis cannot be reached with certainty on the basis of clinical presentation and HRCT alone. When the sampling site is guided by HRCT and multidisciplinary approach, a single biopsy is enough to arrive at a histological diagnosis. Our experience has shown no added advantage in taking more than a single biopsy in this regard. Even though in our experience there was no statistical difference in terms of length of post-operative hospital stay or chest drainage, multiple lung biopsies, however, result in more operative time and attendant increase in cost by the use of more lung stapler re-loads.