SURGICAL LUNG BIOPSY FOR DIFFUSE LUNG DISEASE: A TOOL OR A WEAPON?

DEFRANCHI S; BERTOLOTTI A; FAVALORO RR; CÁNEVA J; OSSES J; VIGLIANO C

Florida

Congreso; The Society of Thoracic Surgeons. 46th Annual Meeting Fort Lauderdale; 2010

The Society of Thoracic Surgeons

Purpose: Surgical lung biopsy (SLB) for Diffuse Lung Disease (DLD) has been associated with high morbidity and mortality rates. There are no many reports that address the value of SLB in recipients of organ transplantation. Our objective is to determine preoperative characteristics and group of patients that might benefit or be at risk from SLB. Methods: Retrospective review of patients with SLB performed at our Institution between March 2004 and March 2009 for DLD.   Results: Sixty patients had SLB. Median age was 50 years (16 to 74 years). Thirty three (55%) were females. Computed tomography (CT) finding was diffuse pulmonary infiltrates 40% of the times and the need for diagnosis was the indication for SLB in 70% of patients. Thirty four patients (57%) had a prior organ transplant. The finding of a specific entity in the SLB was more likely to affect treatment (Table). When diffuse pulmonary infiltrates with nodules was the CT scan pattern, a trend towards making specific diagnosis (p=0.08) and starting a new treatment (p=0.07) was found. Transplanted patients were more likely to be on mechanical ventilation at the time of the SLB (35% vs. 11%; p=0.03). A specific diagnosis was done in 59% transplanted patients vs. 35% of non-transplanted (p=0.06), changing treatment 29% vs. 38% of the times, respectively (p=0.46). Operative mortality was 7% (4/60). In-hospital mortality from causes unrelated to the SLB were more common in patients on mechanical ventilation (57 vs. 7%; p=0.001) and transplanted patients (28 vs. 8%; p=0.06), although this last one did not reach statistical significance. Conclusions: Certain CT scan findings might be associated with a higher diagnosis yield for SLB. SLB changes the treatment in one third of the patients, with no significant difference between transplanted and no-transplanted ones. SLB does not appear to be beneficial for ventilated patients. Judicious clinical evaluation is necessary to decide whether or not to perform a SLB.