单孔与多孔电视辅助胸腔镜肺活检用于疑似间质性肺疾病：关于诊断效能和住院时间的观点
Single versus multiple video-assisted thoracocopic lung biopsy for suspected interstitial lung disease: a perspective on diagnostic efficacy and length of hospital stay.
作者信息
Demiröz Şevki Mustafa, Fındık Göktürk, Türk İlteriş, Aydoğdu Koray, İncekara Funda, Demirağ Funda, Gülhan Selim Şakir Erkmen, Kaya Sadi
机构信息
Department of Thoracic Surgery, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey.
Department of Pathology, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey.
出版信息
Indian J Thorac Cardiovasc Surg. 2022 Nov;38(6):607-612. doi: 10.1007/s12055-022-01408-0. Epub 2022 Sep 9.
BACKGROUND
Nearly one-third of the patients with interstitial lung disease (ILD) require surgical biopsy for a definite diagnosis. Video-assisted thoracoscopic surgical (VATS) biopsy has replaced open lung biopsy, but the number of biopsy required to achieve an accurate diagnose is controversial.
OBJECTIVES
Our study aims to show that a well-planned single VATS biopsy is as effective as multiple biopsies for the accurate diagnosis of ILD by reduced days of hospital stay.
METHODS
We included 111 patients with suspected ILD who underwent VATS biopsy in our study. Patients were separated into three groups according to the number of biopsies obtained. The differences between groups for diagnostic yield, mean time for chest tube removal, perioperative complications, and approximate volume per biopsy were analyzed statistically.
RESULTS
Eighteen single, 74 double, and 19 triple biopsies were made. Mean times of chest tube removal and hospital stay for single, double, and triple biopsy were 3.5, 4.8, and 6.1 days respectively. The number of biopsy and length of hospital stay was strongly related ( = 0.02), but there was no difference for diagnostic yield between single and multiple biopsy groups ( > 0.05). There was no intraoperative complication or perioperative mortality. In postoperative period, eight patients with multiple biopsies had prolonged air leak.
CONCLUSION
Although classical knowledge suggests multiple biopsies from different locations of the lung are essential, recent reports have shown that the site and the number of biopsy are not as effective as previously thought in achieving the diagnosis for ILD. Our results show that a "single" biopsy, decided with multidisciplinary evaluation, is an effective and safe diagnostic tool, with lesser days of hospital stay.
MAIN NOVEL ASPECTS
- The classical knowledge that multiple biopsies should be taken from different regions of the lung in the diagnosis of interstitial lung diseases has changed over time.2. Diagnostic concordance between multiple biopsy specimens is above 85%.3. A "single" biopsy, decided with multidisciplinary evaluation, is an effective and safe diagnostic tool with lower days of hospital stay.
背景
近三分之一的间质性肺疾病（ILD）患者需要进行外科活检以明确诊断。电视辅助胸腔镜手术（VATS）活检已取代开放性肺活检，但为实现准确诊断所需的活检次数仍存在争议。
目的
我们的研究旨在表明，通过减少住院天数，精心规划的单次VATS活检在准确诊断ILD方面与多次活检一样有效。
方法
我们纳入了111例疑似ILD且在我们研究中接受VATS活检的患者。根据获取的活检次数将患者分为三组。对各组之间的诊断阳性率、胸管拔除平均时间、围手术期并发症以及每次活检的大致体积差异进行统计学分析。
结果
进行了18次单次活检、74次双次活检和19次三次活检。单次、双次和三次活检的胸管拔除平均时间和住院时间分别为3.5天、4.8天和6.1天。活检次数与住院时间密切相关（ = 0.02），但单次活检组和多次活检组之间的诊断阳性率无差异（ > 0.05）。无术中并发症或围手术期死亡。在术后期间，8例多次活检的患者出现持续漏气。
结论
尽管传统观点认为从肺的不同部位进行多次活检至关重要，但最近的报告表明，活检部位和次数在实现ILD诊断方面并不像以前认为的那样有效。我们的结果表明，经多学科评估决定的“单次”活检是一种有效且安全的诊断工具，住院天数更少。
主要新观点
- 在间质性肺疾病诊断中，应从肺的不同区域进行多次活检的传统观念已随时间发生变化。2. 多个活检标本之间的诊断一致性超过85%。3. 经多学科评估决定的“单次”活检是一种有效且安全的诊断工具，住院天数更少。
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