Service de Pneumologie, Centre de Référence des maladies pulmonaires rares, FHU APOLLO, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.
Service de Chirurgie vasculaire, thoracique, et transplantation pulmonaire, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.
Ann Thorac Surg. 2022 Sep;114(3):1022-1028. doi: 10.1016/j.athoracsur.2021.07.038. Epub 2021 Aug 14.
Diagnosis of interstitial lung disease is based on the analysis of clinical, biological, radiological, and pathological findings during a multidisciplinary discussion (MDD). When a definitive diagnosis is not possible, guidelines recommend obtaining lung samples through surgical lung biopsy (SLB). We sought to determine morbidity, mortality, diagnostic yield, and therapeutic impact of SLB in the management of patients with interstitial lung disease.
We retrospectively analyzed morbidity, mortality, diagnostic yield, and therapeutic changes after SLB for interstitial lung disease performed electively from January 2015 to May 2019 in a reference center. Each case was reviewed during 2 MDDs, first without and then with the result of the SLB.
The study group included 73 patients (56% male, age 66 [interquartile range (IQR), 57-70] years, forced vital capacity 79% [IQR, 69%-91%], diffusing capacity of the lungs for carbon monoxide 52% [IQR, 46%-63%]). Median postoperative hospital length of stay was 2 (IQR, 0-11) days. Thirteen (17%) patients experienced at least 1 complication, including pain at 1 month (n = 8) and residual pneumothorax (n = 6). No serious complication or postoperative death was noticed. After the first retrospective MDD, the working diagnosis was idiopathic nonspecific interstitial pneumonia in 20 (27%), idiopathic pulmonary fibrosis in 18 (25%), fibrotic hypersensitivity pneumonitis in 15 (21%), unclassifiable interstitial lung disease in 5 (7%), and other diagnosis in 15 (21%) patients. After SLB and second retrospective MDD, the final diagnosis was modified in 35 (48%) patients and led to therapeutic changes in 33 (45%) patients.
SLB is associated with no serious complication or death and notably changes the diagnosis and treatment of interstitial lung disease.
间质性肺疾病的诊断基于在多学科讨论（MDD）期间对临床、生物学、影像学和病理学发现的分析。当无法明确诊断时，指南建议通过外科肺活检（SLB）获取肺样本。我们旨在确定 SLB 在管理间质性肺疾病患者中的发病率、死亡率、诊断率和治疗效果。
我们回顾性分析了 2015 年 1 月至 2019 年 5 月在一家参考中心进行的、用于间质性肺疾病的选择性 SLB 的发病率、死亡率、诊断率和治疗变化。在 2 次 MDD 期间对每个病例进行了回顾，第一次回顾时没有，第二次回顾时则有 SLB 的结果。
研究组包括 73 名患者（56%为男性，年龄 66 [四分位距（IQR），57-70] 岁，用力肺活量 79% [IQR，69%-91%]，一氧化碳弥散量 52% [IQR，46%-63%]）。术后中位住院时间为 2（IQR，0-11）天。13（17%）名患者至少经历了 1 种并发症，包括 1 个月时的疼痛（n=8）和残余气胸（n=6）。未发现严重并发症或术后死亡。在第一次回顾性 MDD 后，工作诊断为特发性非特异性间质性肺炎 20 例（27%）、特发性肺纤维化 18 例（25%）、纤维化性过敏性肺炎 15 例（21%）、无法分类的间质性肺疾病 5 例（7%）和其他诊断 15 例（21%）。在 SLB 和第二次回顾性 MDD 后，35 例（48%）患者的最终诊断发生了改变，并导致 33 例（45%）患者的治疗发生了改变。
SLB 无严重并发症或死亡，显著改变了间质性肺疾病的诊断和治疗。
