Does lung biopsy help patients with interstitial lung disease?
OBJECTIVE
The decision to perform lung biopsy in the evaluation of interstitial lung disease (ILD) is based on the probability that this examination will yield a specific diagnosis, leading to a change in treatment. The purpose of this study was to identify factors that influence the diagnostic yield of lung biopsy for ILD.


METHODS
One hundred patients underwent lung biopsy for ILD over a 5-year period. There were 59 men and 41 women; with a median age of 51.5 years. Thirty percent underwent open lung biopsy, while 70% had videothoracoscopic biopsy. Patient and disease characteristics, prior diagnostic studies, pre-operative therapy, biopsy type, site, size, number, and laterality were compared to identify factors that might influence diagnostic yield.


RESULTS
Forty-two percent had a specific diagnosis, while 58% had a non-specific diagnosis. Right side was selected in 57.1% of patients with a specific diagnosis and 48.3% of patients without a specific diagnosis (P=0.381). Right lower lobe was the main site for biopsy in the specific diagnosis group compared to the non-specific group (35.7 versus 20.7%, P=0.095). Left upper lobe was the main site for biopsy in the non-specific diagnosis group compared to the specific diagnosis group (41.4 versus 23.8%, P=0.067). Mean volume of biopsy was 12.3 cm(3) in the specific diagnosis group and 12 cm(3) in the non-specific diagnosis group (P=0.373). Two or more biopsies were carried out in 38.1% of the specific diagnosis group compared to 25.9% of the non-specific diagnosis group (P=0.192). There were no significant factors in predicting a diagnostic yield. Of those patients with a specific diagnosis, 59.5% had therapy altered, compared to 55.2% of those with a non-specific diagnosis (P=0.664).


CONCLUSIONS
Lung biopsy does not always provide a specific diagnosis and does not always change therapy. The site, size, number, and laterality of the biopsy specimen have no definite influence on diagnosis. There is a trend to improve diagnostic yield by carrying out two or more biopsies on the right lung.
Qureshi
Rizwan A
RA
Department of Thoracic Surgery, The Cardiothoracic Centre-Liverpool, Thomas Drive, Liverpool L14 3PE, UK.
Ahmed
Tanveer A
TA
Grayson
Antony D
AD
Soorae
Ajaib S
AS
Drakeley
M John
MJ
Page
Richard D
RD
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001706:Biopsy; D002277:Carcinoma / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016015:Logistic Models; D008168:Lung / Q000098:blood supply* / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000188:drug therapy; D008175:Lung Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000175:diagnosis; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis; D012680:Sensitivity and Specificity
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents