Efficacy and safety of videothoracoscopic lung biopsy in the diagnosis of interstitial lung disease

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Abstract
OBJECTIVE: The aim of this study was to determine the efficacy andsafety of videothoracoscopic lung biopsy (VTLB) in the diagnosis ofinfiltrative lung disease (ILD) and compare the results of VTLB with theresults previously obtained in patients with open lung biopsy at the sameinstitution. METHODS: Forty-one patients undergoing VTLB between May 1991and December 1994 were retrospectively studied and compared with 25patients who have undergone OLB during the period from January 1987 toApril 1991. The two groups were comparable with respect to age, sex, andseverity of lung disease. RESULTS: Three of 41 patients (7%) who underwentVTLB with minithoracotomy. There was no significant difference between thegroup of VTLB (38 patients) and the group OLB (25 patients) with regard to,the number of biopsies (VTLB 1.8 +/- 0.4 versus OLB 2 +/- 0.6), ordiagnostic yield (VTLB 37/38 versus OLB 25/25). In contrast, patients whounderwent VTLB demonstrated a significant reduction of the operative time(VTLB 45.3 +/- 12.2 min), length of chest tube drainage (3.55 +/- 1.2days), hospital stay (5.5 +/- 1.3 days), and analgesia (buprenorphine 0.85+/- 0.44 mg; paracetamol 5.9 +/- 2.5 g) compared to patients who underwentOLB (55.6 +/- 11.2 min, 5.2 +/- 1.5 days; 7.1 +/- 2.3 days; buprenorphine1.17 +/- 0.5 mg, paracetamol 8.9 +/- 2.3 g). Morbidity and mortality weresimilar in the two groups (morbidity VTLB 10.5%, OLB 12%; mortality VTLB5.2%, OLB 8%). Regardless of the biopsy technique, the most seriouscomplications and deaths occurred with the same frequency in those patientswith a severe underlying disease. CONCLUSIONS: VTLB is a valid alternativeto OLB in most cases. Along with a comparable efficacy, VTLB has severaladvantages that should make it the method of choice for patients with onlyminimally impaired respiratory function. In contrast, the role andadvantages of VTLB compared to OLB in patients with severe lung disease,require further investigation.