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Ann Thorac Surg 2007;84:2136-2137. doi:10.1016/j.athoracsur.2007.07.076
© 2007 The Society of Thoracic Surgeons
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Correspondence

Video-Assisted Thoracoscopic Lung Biopsy in Patients With Interstitial Lung Disease

Rizwan A. Qureshi, FRCS, Steven A. Stamenkovic, FRCS, Fiona M. Carnochan, FRCS, Wiliam S. Walker, FRCS

Department of Thoracic Surgery, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Rd, Edinburgh EH 16 4SA, United Kingdom

(Email: rizwanqureshi2{at}aol.com).

To the Editor:

We read with interest the study by Kreider and colleagues [1], which emphasizes that video-assisted thoracoscopic surgery (VATS) for lung biopsy is not without risk.

The efficacy of VATS for lung biopsy has been previously determined [2–4]. The VATS procedure is more aesthetic, less painful, cost effective, and offers a lower postoperative morbidity and higher diagnostic yield than open-lung biopsy in a selected group of patients.

Nevertheless, it is important to keep certain caveats in mind. Despite low morbidity and high accuracy of VATS for lung biopsy, the standard indications for operation should not be altered.

Specifically high-yield and low-risk methods, such as bronchoscopy, bronchoalveolar lavage, transbronchial biopsy, and transthoracic needle biopsy, should still be considered as initial diagnostic tests.

The VATS technique requires single-lung ventilation and this can be made difficult by a lung that fails to collapse or has multiple adhesions.

We agree with Miller and colleagues [5] that open-lung biopsy through a limited thoracotomy is an appropriate option in these patients at high risk for single-lung ventilation who are critically ill or whose operative risks are otherwise high, particularly those with significant respiratory insufficiency.

Most forms of interstitial lung disease rarely remit and feature periods of exacerbation superimposed on a chronic or worsening baseline of symptoms. Therefore, it is something of an art to keep such patients functional, hopeful, and moderately satisfied with their medical care.

The careful selection of patients for surgical lung biopsy is crucial and we believe that due consideration should be given to whether the patient will benefit from this procedure in proportion to the anticipated risk.


   References
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 References
 

  1. Kreider ME, Hansen-Flaschen J, Ahmad NN, Rossman, MD, et al. Complications of video-assisted thoracoscopic lung biopsy in patients with interstitial lung disease Ann Thorac Surg 2007;83:1140-1144.[Abstract/Free Full Text]
  2. Qureshi RA, Soorae AA. Efficacy of thoracoscopic lung biopsy in interstitial lung diseases: comparison with open lung biopsy J Coll Physicians Surg Pak 2003;13:600-603.[Medline]
  3. Qureshi RA, Ahmed TA, Grayson AD, Soorae AS, Drakeley MJ, Page RD. Does lung biopsy help patients with interstitial lung disease? Eur J Cardiothorac Surg 2002;21:621-626discussion 626.[Abstract/Free Full Text]
  4. Carnochan FM, Walker WS, Cameron EW. Efficacy of video-assisted thoracoscopic lung biopsy: an historical comparison with open lung biopsy Thorax 1994;49:361-363.[Abstract/Free Full Text]
  5. Miller JD, Urschel JD, Cox G, Olak J, et al. A randomized, controlled trial comparing thoracoscopy and limited thoracotomy for lung biopsy in interstitial lung disease Ann Thorac Surg 2000;70:1647-1650.[Abstract/Free Full Text]




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