Efficacy of thoracoscopic lung biopsy in interstitial lung diseases: comparison with open lung biopsy.

Objective: To determine the efficacy of video-assisted thoracoscopic surgery (VATS) compared to open lung biopsy.

Design: Descriptive, observational case series.

Place And Duration Of Study: The Cardio-thoracic Centre, Liverpool, UK, from January 1995 to December 1999.

Patients And Methods: One hundred consecutive patients, undergoing lung biopsy for interstitial lung disease during this period, were included in the study. Thirty patients underwent open lung biopsy, while 70 patients had VATS lung biopsy. Patient characteristics, site, size, number and laterality of biopsy, complications, morbidity, mortality and diagnostic yield was compared. P-value was determined to assess significance of findings. Statistical analysis was performed on SAS for windows version 8.

Results: Seventy-five percent had diagnostic yield in VATS group, while 37% in open group (p=0.04). Mean FEV1 was 3.2 litre in VATS group and 1.92 litre in open group (p=0.05). Right side was selected in 58.6% in VATS group and 36.7% in open group (p =0.04). Right lower lobe was the main site for biopsy in the VATS group compared to open group (18.6% versus 3.3%, p=0.04). Mean volume of biopsy was 15.6 cm3 in VATS group and 12.5 cm3 in open group (p=0.04). Two or more biopsies were carried out in 37.1% of the VATS group compared to 16.7% of the open group (p=0.04). Chest drain duration was in 1 day in VATS group compared to 2 days in open group (p=0.01). Length of stay was 3 days in VATS group and 4 days in open group (p=0.003).

Conclusion: Patients undergoing thoracoscopic lung biopsy had a significantly reduced chest drain duration and post-operative length of stay. Thoracoscopic lung biopsy is beneficial in determining a diagnostic yield with an advantage of greater volume and selection of biopsy sites.