Abstract
BackgroundDiagnosing a specific type of Interstitial Lung Disease (ILD) is a challenging process and often necessitates that a Video-assisted Thoracoscopic Surgery (VATS) Lung Biopsy be performed. By analysing the proportion of patients who have their treatment changed after undergoing a VATS lung biopsy, this study aimed to determine the utility of performing this procedure in patients with ILD.MethodsThe clinical data from sixty-six patients with suspected ILD, who underwent VATS lung biopsies at the New Royal Infirmary of Edinburgh (NRIE) in the period of 16th May 2011 – 11th February 2013, were analysed retrospectively. The main outcome measures considered in this study were: CT scan differential diagnoses, VATS lung biopsy histological differential diagnoses, post-VATS lung biopsy consensus diagnoses, 30-day mortality, surgical complications (minor and major), resultant changes in treatment and responses to these changes in treatment.ResultsFollowing VATS biopsy a definite pathological diagnosis was made in 74.2% of cases. A change in treatment was initiated in 47.2% of patients, including in 80% of patients diagnosed with Hypersensitivity Pneumonitis and 60% of patients diagnosed with sarcoidosis. A positive response to treatment was experienced in 58% of patients whom underwent a change in treatment. Only 54% of patients who received a consensus diagnosis of UIP after VATS lung biopsy, had been given a differential diagnosis of “probable UIP” at CT scan. 15% of patients who received a differential diagnosis of “probable UIP” at CT scan, had their diagnosis changed to Hypersensitivity Pneumonitis after lung biopsy. There was one mortality (1.5%) in this series of patients and no other major complications. Minor complications to surgery were experienced in 28.8% of patients.ConclusionsThis study highlights the effectiveness of performing VATS lung biopsies in patients with suspected ILD. The procedure leads to a change in treatment in almost half of all patients, including in the vast majority of cases of Hypersensitivity Pneumonitis. It also prevents what would be the inappropriate over-treatment of UIP. It has been shown to be a relatively safe procedure and thus, should be performed in all patients with suspected ILD, indeterminate in type from prior CT imaging.
Highlights
Diagnosing a specific type of Interstitial Lung Disease (ILD) is a challenging process and often necessitates that a Video-assisted Thoracoscopic Surgery (VATS) Lung Biopsy be performed
Interstitial Lung Disease (ILD) denotes a collection of heterogeneous lung diseases which all primarily affect the interstitium of the lung
There are reported to be more than 200 different subtypes of ILD, so achieving a correct specific diagnosis is often challenging in a patient with ILD
Summary
Diagnosing a specific type of Interstitial Lung Disease (ILD) is a challenging process and often necessitates that a Video-assisted Thoracoscopic Surgery (VATS) Lung Biopsy be performed. ILD most commonly presents with dyspnoea or a dry cough. Systemic features, such as weight loss or fatigue, are common at presentation. There are reported to be more than 200 different subtypes of ILD, so achieving a correct specific diagnosis is often challenging in a patient with ILD. This is of vital importance though, because the subtypes of ILD have different management protocols
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