title: The role of surgical lung biopsy in the management of interstitial lung disease: experience from a single institution in the UK.
abstract: OBJECTIVE
  Interstitial lung disease (ILD) includes a wide spectrum of pulmonary pathologies. The role of surgical lung biopsy (SLB) in the diagnosis of ILD is still controversial. The purpose of this study was to ascertain whether SLB is worthwhile in the management of ILD.
  
  
  METHODS
  One hundred and three patients underwent SLB for ILD from April 2008 to March 2010 at a single institution. Outcomes included patient demographics, preoperative investigations, preoperative diagnosis and treatment, surgical approach, number and site of biopsies, complications, length of postoperative stay and postoperative pathological diagnosis and treatment.
  
  
  RESULTS
  Fifty-one (49.6%) patients were male and 52 (50.4%) were female. The median age was 58 (range 26-78). Major complications were seen in 7 patients (6.8%). Five patients (4.9%) died within 30 days following surgery. Definitive pathological diagnosis (DPD) was reached in 72 (69.9%) patients, whereas no DPD was achieved in 31 (30.1%). Within the group of patients who received DPD, this differed from the clinical diagnosis in 53 patients (51.5%), and was concordant in 19 (18.4%). The DPD was helpful in guiding the management of 47 patients (45.6%), who had a change in their treatment following the procedure. The median hospital stay was 4 days (range 2-42 days).
  
  
  CONCLUSIONS
  SLB is a well-recognized procedure. Although it provides a diagnosis for the majority of patients, in our series SLB was inconclusive in a considerable number of cases and did not lead to a therapeutic change for more than half of all patients. Furthermore, SLB is not without risk and can be associated with a prolonged hospital stay. We believe that SLB should be performed in a select group of patients with ILD after discussion by a multidisciplinary panel.
authors.affiliation: Department of Thoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK.
authors.forename: Vivienne
authors.initials: V
authors.lastname: Blackhall
authors.forename: Mohammed
authors.initials: M
authors.lastname: Asif
authors.forename: Alessandra
authors.initials: A
authors.lastname: Renieri
authors.forename: Serenella
authors.initials: S
authors.lastname: Civitelli
authors.forename: Alan
authors.initials: A
authors.lastname: Kirk
authors.forename: Ali
authors.initials: A
authors.lastname: Jilaihawi
authors.forename: Felice
authors.initials: F
authors.lastname: Granato
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D017563:Lung Diseases, Interstitial / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: Biopsy; Interstitial lung disease; Video-assisted thoracic surgery