title: Do the number and volume of surgical lung biopsies influence the diagnostic yield in interstitial lung disease? A propensity score analysis.
abstract: BACKGROUND
  Our objective was to evaluate whether the number and volume of surgical lung biopsies (SLB) influence the diagnosis of diffuse interstitial lung disease (ILD).
  
  
  METHODS
  Retrospective study of SLB for suspected ILD in patients from the Mayo Clinic from January 2002 to January 2010. Data were collected in the institution and analyzed.
  
  
  RESULTS
  311 patients were studied. Mean number of biopsies was 2.05 (SD 0.6); 1 biopsy in 50 (16%), 2 in 198 (63.7%), 3 in 59 (19%) and 4 in 4 (1.3%). Histopathologic diagnosis was: definitive (specific): 232 (74.6%), descriptive (non-specific): 76 (24.4%), no diagnosis: 3 (1%). After excluding patients without diagnosis (n=3), there were 50 patients with only 1 biopsy, 196 with 2 and 62 with 3 or 4; the definitive diagnostic yield was similar in all 3 groups (37/50; 74%, 150/196; 77%, and 45/62; 73%) (Chi-square, p value 0.8). The propensity score analysis between patients with 1 SLB and patients with more than 1 SLB also showed no difference in diagnostic yield. Regarding the volume of biopsies, mean total volume was 34.4 cm(3) (SD 46): 41.2 cm(3) (3 cases) in patients with no diagnosis; 33.6 cm(3) (232 cases, SD 47) in patients with specific diagnosis; and 36.6 cm(3) (76 cases, SD 44) in patients with descriptive diagnosis. Biopsy volume had no influence on histopathology yield (ANOVA, p value .8).
  
  
  CONCLUSIONS
  The number and volume of the biopsy specimens in SLB did not seem to influence diagnosis. Based on our results, we believe a single sample from a representative area may be sufficient for diagnosis. Randomized prospective trials should be performed to optimize SLB for ILD.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Estados Unidos. Electronic address: juanjofibla@gmail.com.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Fibla
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Estados Unidos.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Estados Unidos.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Estados Unidos.
authors.forename: Dennis
authors.initials: D
authors.lastname: Wigle
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Estados Unidos.
authors.forename: Robert
authors.initials: R
authors.lastname: Shen
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Estados Unidos.
authors.forename: Francis
authors.initials: F
authors.lastname: Nichols
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Estados Unidos.
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Estados Unidos.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000542:Alveolitis, Extrinsic Allergic / Q000175:diagnosis / Q000473:pathology; D001706:Biopsy / Q000379:methods / Q000706:statistics & numerical data*; D001988:Bronchiolitis / Q000175:diagnosis / Q000473:pathology; D001999:Bronchoscopy; D018549:Cryptogenic Organizing Pneumonia / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011658:Pulmonary Fibrosis / Q000175:diagnosis / Q000473:pathology; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D055815:Young Adult
keywords: Biopsia pulmonar y quirúrgica; Diagnostic yield; Enfermedad pulmonar intersticial; Interstitial lung disease; Rendimiento diagnóstico; Surgical lung biopsy