Mortality after surgical lung biopsy for the evaluation of interstitial lung diseases
More details
Hide details
7th Department of Pneumonology, Athens Chest Diseases Hospital ‘Sotiria’, Greece
2nd Department of Pneumonology, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
1st Department of Pneumonology, Interstitial Lung Disease Unit, Hospital for Diseases of the Chest ‘Sotiria’, Athens;Medical School, National and Kapodistrian University of Athens, Greece
Demosthenes Bouros   

Athens Chest Diseases Hospital "Sotiria", 152 Mesogion Αv., Athens 11527, Greece
Publication date: 2021-06-17
Pneumon 2016;29(1):33–39
Interstitial lung diseases (ILD) represent a heterogeneous group of disorders in which the aetiology, not infrequently, remain unknown. Specific ILD requires a multi-disciplinary approach (MDD), in expert reference centers for diffuse parenchymal lung diseases (DPLD), using a stepwise approach which sometimes ends with the request of tissue sampling. The standard procedure to obtain histology in undefined ILD is the surgical lung biopsy (SLB) via video-thoracoscopy (VATS). However, SLB is associated with significant postoperative morbidity and mortality, and the physician must weigh carefully risks and benefits when a SLB is considered. VATS lung biopsy appears to be safer than open biopsy with an associated 90-day mortality that is somewhat lower, but not negligible, at approximately 3.4%. Last but not least, higher mortality risk may occur in patients whose ultimate diagnosis is idiopathic pulmonary fibrosis (IPF), as SLB in patients with IPF may trigger an acute exacerbation of IPF. Confirming the diagnosis and differentiating among specific forms of ILDs may though not be possible without performing SLB. Newer techniques, such as uniportal VATS under thoracic epidural anesthesia or intercostals block or transbronchial cryobiopsy may increase the safety of tissue sampling in undefined ILD patients.
All the authors declare that they do not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.
American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. Am J Respir Crit Care Med 2002;165:277-304.
An Official ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-based Guidelines for Diagnosis and Management. Am J Respir Crit Care Med 2011;183:788-824.
Lettieri CJ, Veerappan GR, Helman DL, et al. Outcomes and safety of surgical lung biopsy for interstitial lung disease. Chest 2005;127:1600-5.
American Thoracic Society, European Respiratory Society. Idiopathic Pulmonary Fibrosis, diagnosis and treatment. International Consensus statement. Am J Respir Crit Care Med 2000;161:646-64.
An Official ATS/ERS statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 2013;188:733-48.
Ryerson CJ, Urbania TH, Richeldi L, et al. Prevalence and prognosis of unclassifiable interstitial lung disease. Eur Respir J 2013;42:750-7.
Tominagaa J, Sakai F, Takeshi Johkoh T, et al. Diagnostic certainty of idiopathic pulmonary fibrosis/usual interstitial pneumonia: The effect of the integrated clinico-radiological assessment. Eur J Radiol 2015;84:2640-5.
Flaherty KR, Toews GB, Travis WD, et al. Clinical significance of histological classification of idiopathic interstitial pneumonia. Eur Respir J 2002;19:275-83.
Mouroux J, Clary-Meinesz C, Padovani B, et al. Efficacy and safety of videothoracoscopic lung biopsy in the diagnosis of interstitial lung disease. Eur J Cardiothorac Surg 1997;11:22-4.
Ferson PF. Thoracoscopic wedge resection of the lung. Surg Rounds 1993;16:341.
McKenna RJ Jr. Thorascopic evaluation and treatment of pulmonary disease. Surg Clin North Am 2000;80:1543-53.
Low JM. Anesthesia for video-assisted thoracic surgery. In: Yim APC, Hazelrigg SR, Izzsat MB, et al., editors. Minimal access cardiothoracic surgery. Philadelphia: WB Saunders Co.;2000. pp. 21-7.
Halkos ME, Gal AA, Kerendi F, et al. Role of thoracic surgeons in the diagnosis of idiopathic interstitial lung disease. Ann Thorac Surg 2005;79:2172-9.
Ryu JH, Daniels GE, Hartman TE, et al. Diagnosis of interstitial lung diseases. Mayo Clin Proc 2007;82:976-86.
Nguyen W, Meyer KC. Surgical lung biopsy for the diagnosis of interstitial lung disease: a review of the literature and recommendation for optimizing safety and efficacy. Sarcoidosis Vasc Diffuse Lung Dis 2013;30:3-16.
Danoff SK, Terry PB, Horton MR. A clinician’s guide to the diagnosis and treatment of interstitial lung diseases. South Med J 2007;100:579-87.
Bradley B, Branley HM, Egan JJ, et al. British Thoracic Society Interstitial Lung Disease Guideline Group, British Thoracic Society Standards of Care Committee; Thoracic Society of Australia; New Zealand Thoracic Society; Irish Thoracic Society. Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax. 2008;63(Suppl 5):v1-58.
Nicholson AG, Addis BJ, Bharucha H, et al. Inter-observer variation between pathologists in diffuse parenchymal lung disease. Thorax 2004;59:500-5.
Carrillo G, Estrada A, Pedroza J, et al. Preoperative risk factors associated with mortality in lung biopsy patients with interstitial lung disease. J Invest Surg 2005;18:39-45.
Kreider ME, Hansen-Flaschen J, Ahmad NN, et al. Complications of video assisted thoracoscopic lung biopsy in patients with interstitial lung disease. Ann ThoracSurg 2007;83:1140-4.
Sakamoto S, Homma S, Mun M, et al. Acute exacerbation of idiopathic interstitial pneumonia following lung surgery in 3 of 68 consecutive patients: a retrospective study. Intern Med 2011;50:77-85.
Kolb M, Shargall Y. Lung surgery in interstitial lung disease-a safe and useful procedure? J Thorac Dis 2013;5:375-7.
Han Q, Luo Q, Xie JX, et al. Diagnostic yield and postoperative mortality associated with surgical lung biopsy for evaluation of interstitial lung diseases: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2015;149:1394-401.
Bando M, Ohno S, Hosono T, et al. Risk of acute exacerbation after video-assisted thoracoscopic lung biopsy for interstitial lung disease. J Bronchology Interv Pulmonol 2009;16:229-35.
Fibla JJ, Brunelli A, Cassivi SD, et al. Aggregate risk score for predicting mortality after surgical biopsy for interstitial lung disease. Interact Cardiovasc Thorac Surg 2012;15:276-9.
Utz JP, Ryu JH, Douglas WW, et al. High short-term mortality following lung biopsy for usual interstitial pneumonia. Eur Respir J 2001;17:175-9.
Kondoh Y, Taniguchi H, Kitaichi M, et al. Acute exacerbation of interstitial pneumonia following surgical lung biopsy. Respir Med 2006;100:1753-9.
Ghatol A, Parker Ruhl A, Danoff SK. Exacerbations in Idiopathic Pulmonary Fibrosis Triggered by Pulmonary and Non pulmonary Surgery: A Case Series and Comprehensive Review of the Literature. Lung 2012;190:373-80.
Papiris S, Manali E, Kolilekas L, et al. Idiopathic Pulmonary Fibrosis Acute Exacerbations: Unravelling Ariadne’sthread. Crit Care 2010;14:246.
Suzuki H, Sekine Y, Yoshida S, et al. Risk of acute exacerbation of interstitial pneumonia after pulmonary resection for lung cancer in patients with idiopathic pulmonary fibrosis based on preoperative high-resolution computed tomography. Surg Today 2011;41:914-21.
Watanabe A, Kawaharada N, Higami T. Postoperative acute exacerbation of IPF after lung resection for primary lung cancer. Pulm Med 2011;960316.
Fischer GW, Cohen E. An update on anesthesia for thoracoscopic surgery.Curr Opin Anaesthesiol 2010;23:7-11.
Luo Q, Han Q, Chen X, et al. The diagnostic efficacy and safety of video assisted thoracoscopy surgery (VATS) in undefined interstitial lung diseases: a retrospective study. J Thorac Dis 2013;5:283-8.
Ambrogi V, Mineo TC. VATS biopsy for undetermined interstitial lung disease under non-general anesthesia: comparison between uniportal approach under intercostal block vs. three-ports in epidural anesthesia. J Thorac Dis 2014;6:888-95.
Mineo TC, Ambrogi V. Efficacy of awake thoracic surgery. J Thorac Cardiovasc Surg 2012;143:249-50.
Kropski JA, Pritchett JM, Mason WR, et al. Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease. PLoS One 2013;8:e78674.
Poletti V, Casoni GL, Gurioli C, et al. Lung cryobiopsies: a paradigm shift in diagnostic bronchoscopy? Respirology 2014;19:645-54.
Tomassetti S, Wells AU, Costabel U, et al. Bronchoscopic lung cryobiopsy increases diagnostic confidence in the multidisciplinary diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2015;Nov 12. [Epub ahead of print].
Gershman E, Fruchter O, Benjamin F, et al. Safety of cryotransbronchial biopsy in diffuse lung diseases: analysis of three hundred cases. Respiration 2015;90:40-6.
Ravaglia C, Bonifazi M, Wells AU, et al. Safety and diagnostic yield of transbronchial lung cryobiopsy in diffuse parenchymal lung diseases: a comparative study versus video-assisted thoracoscopic lung biopsy and a systematic review of the literature. Respiration 2016;91:215-27.
Dhooria S, Sehgal IS, Aggarwal AN. Diagnostic Yield and Safety of Cryoprobe Transbronchial Lung Biopsy in Diffuse Parenchymal Lung Diseases: Systematic Review and Meta-Analysis. Respir Care 2016;Mar 1. pii: respcare.04488. [Epub ahead of print].
Poletti V, Hetzel J. Transbronchial cryobiopsy in diffuse parenchymal lung disease: need for procedural standardization. Respiration 2015;90:275-8.
Romagnoli M, Bourdin A. Transbronchial cryobiopsy in the evaluation of interstitial lung diseases: Time for a positioning in the diagnostic work-up approach? Respirology 2015;20,684-6.