title: Videothoracoscopy-assisted surgical lung biopsy for interstitial lung diseases.
abstract: OBJECTIVE
  Surgical lung biopsy (SLB) by videothoracoscopy for diffuse interstitial lung diseases is recommended for detailed diagnosis. Because substantial mortality and morbidity are associated with this procedure, its safety and diagnostic yield should be validated.
  
  
  METHODS
  Sixty-four patients with diffuse interstitial lung disease who received SLB by videothoracoscopy between 2007 and 2013 were retrospectively analyzed for mortality, surgical complication, and diagnosis. Criteria for the procedure included patients <70-year old, who had at least 60 % vital capacity and at least 40 % diffusion capacity. Patients with radiologically definite usual interstitial pneumonia were not eligible.
  
  
  RESULTS
  One conversion from the 3-port approach to thoracotomy due to bleeding occurred. Mean operation and anesthesia times were 63 and 133 min, respectively. The mean hospital stay was 6 days. Only 10 patients (16 %) received prophylactic steroid and/or elastase inhibitor administration. Neither deaths nor acute exacerbations of interstitial pneumonia occurred within 60 days after surgery. Pneumothorax occurred in four cases (6 %) after discharge, which was associated with lower % vital capacity and intraoperative steroid administration. Prolonged air leak and postoperative pneumonia were observed in 2 and 1 patients, respectively. Postoperative diagnosis was obtained in all patients. A group of connective tissue disease-related interstitial pneumonia (n = 15) and chronic hypersensitivity pneumonitis (n = 18) were the major diagnoses. Discordance between pre- and postoperative diagnoses was observed among usual interstitial pneumonia, non-specific interstitial pneumonia, and chronic hypersensitivity pneumonia.
  
  
  CONCLUSIONS
  Surgical lung biopsy for diffuse interstitial lung diseases is safe under appropriate inclusion criteria and provides definite diagnosis.
authors.affiliation: Department of Thoracic Surgery, Kyoto University Hospital, Shogoin-kawara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan, mysonobe@kuhp.kyoto-u.ac.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Sonobe
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Handa
authors.forename: Kiminobu
authors.initials: K
authors.lastname: Tanizawa
authors.forename: Masaaki
authors.initials: M
authors.lastname: Sato
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Sato
authors.forename: Fengshi
authors.initials: F
authors.lastname: Chen
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Omasa
authors.forename: Toru
authors.initials: T
authors.lastname: Bando
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
authors.forename: Michiaki
authors.initials: M
authors.lastname: Mishima
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D007902:Length of Stay; D008168:Lung / Q000473:pathology* / Q000601:surgery; D017563:Lung Diseases, Interstitial / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D055815:Young Adult