ABSTRACT

The usefulness of open lung biopsy in obtaining tissue material for histological diagnosis is undeniable even when technological advances direct us towards minimally invasive methods. The aim of the study is to show the efficiency of open lung biopsy and to discuss the need for pleural drainage when the pleura has been transgressed. Material and methods: Prospective longitudinal study carried out from January 1, 2017 to December 31, 2018, in 41 patients undergoing open lung biopsy by mini-thoracotomy. Results: The study included 41 patients with open lung biopsies. The evolution was satisfactory in 97.5% of the cases and only one patient required the placement of immediate postoperative drainage due to pneumothorax greater than 10%. In 39 (95%) patients, histological diagnosis was obtained independent of the site of the biopsy and two (5%) the sample was reported without abnormalities. Conclusions: The choice of the lung parenchyma biopsy site and the anatomic location of the lesion is not an impediment to the mini-thoracotomy approach and allows obtaining adequate lung tissue for histological diagnosis in the majority of cases. The indication of pleural drainage can be selective according to transoperative criteria and the experience of the surgical team.

KEYWORDS

Lung biopsy, minithoracotomy, pleural drainage.

REFERENCES

1. Raj R, Raparia K, Lynch DA, Brown KK. Surgical lung biopsy for interstitial lung diseases. Chest 2017;151(5):1131-1140. doi: 10.1016/j.chest.2016.06.019.

2. Blackhall V, Asif M, Renieri A, et al. The role of surgical lung biopsy in the management of interstitial lung disease: Experience from a single institution in the UK. Interact Cardiovasc Thorac Surg 2013;17(2):253-257. doi: 10.1093/icvts/ivt217.

3. Torres-Rodríguez T, Aburto A, Morales GJ, Téllez JL, Melchum L, Alejandre JVJ. La biopsia pulmonar a cielo abierto. ¿Modifica la terpéutica final? Rev Inst Nal Enf Resp Méx 1991;4:59.

4. Donaldson LH, Gill AJ, Hibbert M. Utility of surgical lung biopsy in critically ill patients with diffuse pulmonary infiltrates: a retrospective review. Intern Med J 2016;46(11):1306-1310. doi: 10.1111/imj.13222.

5. Marjański T, Halman J, Taniewska S, Burzyńska N, Piekarska A, Sawicka W. Open lung biopsy performed in idiopathic pulmonary fibrosis is a safe procedure. Kardiochir Torakochirurgia Pol 2017;14(4):236-240. doi: 10.5114/kitp.2017.72227.

6. Blewett CJ, Bennett WF, Miller JD, Urschel JD. Open Lung biopsy as an outpatient procedure. Ann Thorac Surg 2001;71(4):1113-1115. doi: 10.1016/S0003-4975(00)02657-6.

7. Libby LJ, Gelbman BD, Altorki NK, Christos PJ, Libby DM. Surgical lung biopsy in adult respiratory distress syndrome: A meta-analysis. Ann Thorac Surg 2014;98(4):1254-1260. doi: 10.1016/j.athoracsur.2014.05.029.

8. Papazian L, Doddoli C, Chetaille B, et al. A contributive result of open-lung biopsy improves survival in acute respiratory distress syndrome patients. Crit Care Med 2007;35(3):755-762. doi: 10.1097/01.CCM.0000257325.88144.30.

9. Kramer MR, Berkman N, Mintz B, Godfrey S, Saute M, Amir G. The role of open lung biopsy in the management and outcome of patients with diffuse lung disease. Ann Thorac Surg 1998;65(1):198-202.

10. Arabi Y, Ahmed R, Ahmed Q, Rahman MU, Yamani N. Risks and benefits of open-lung biopsy in the mechanically ventilated critically ill population: a cohort study and literature review. Med Sci Monit 2007;13(8):CR365-CR371.

11. Almotairi A, Biswas S, Shahin J. The role of open lung biopsy in critically III patients with hypoxic respiratory failure: a retrospective cohort study. Can Respir J 2016;2016:8715024. doi: 10.1155/2016/8715024.

12. Hutchinson JP, McKeever TM, Fogarty AW, Navaratnam V, Hubbard RB. Surgical lung biopsy for the diagnosis of interstitial lung disease in England: 1997-2008. Eur Respir J 2016;48(5):1453-1461. doi: 10.1183/13993003.00378-2016.

13. Kao KC, Chang CH, Hung CY, Chiu LC, Huang CC, Hu HC. Survival predictor in patients with acute respiratory distress syndrome and diffuse alveolar damage undergoing open lung biopsy. PLoS One 2017;12(7):e0180018. doi: 10.1371/journal.pone.0180018.

14. Rotolo N, Imperatori A, Dominioni L, et al. Efficacy and safety of surgical lung biopsy for interstitial disease. Experience of 161 consecutive patients from a single institution in Italy. Sarcoidosis Vasc Diffuse Lung Dis 2015;32(3):251-258.

15. Nguyen W, Meyer KC. Surgical lung biopsy for the diagnosis of interstitial lung disease : a review of the literature and recommendations for optimizing safety and efficacy. Sarcoidosis Vasc Diffuse Lung Dis 2013;30(1):3-16.

16. Koç T, Routledge T, Chambers A, Scarci M. Do patients undergoing lung biopsy need a postoperative chest drain at all? Interact Cardiovasc Thorac Surg 2010;10(6):1022-1025. doi: 10.1510/icvts.2010.232892.

17. Watanabe A, Watanabe T, Ohsawa H, et al. Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung. Eur J Cardiothorac Surg 2004;25(5):872-876. doi: 10.1016/j.ejcts.2004.01.041.

18. Lu TY, Chen JX, Chen PR, et al. Evaluation of the necessity for chest drain placement following thoracoscopic wedge resection. Surg Today 2017;47(5):606-610. doi: 10.1007/s00595-016-1414-5.

19. Satherley LK, Luckraz H, Rammohan KS, Phillips M, Kulatilake NE, O’Keefe PA. Routine placement of an intercostal chest drain during video-assisted thoracoscopic surgical lung biopsy unnecessarily prolongs in-hospital length of stay in selected patients. Eur J Cardiothorac Surg 2009;36(4):737-740. doi: 10.1016/j.ejcts.2009.04.067.