Conference Coverage

Advanced Pleuroscopy Technique Is Biopsy Option for Unknown DPLDs

Major Finding: Good biopsy specimens (average size of 0.5 x 0.4 cm) were obtained and no life-threatening complications occurred in patients who underwent medical thorascopic lung biopsies.

Data Source: A prospective study in 10 patients was conducted.

Disclosures: Neither Dr. Muthiah nor Dr. Elnady had disclosures to report.

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Thoracoscopic Lung Biopsy Is Risky

Dr. Lary Robinson, FCCP, comments: Medical thoracoscopy, commonly termed pleuroscopy, has been practiced for decades in some centers by pulmonary medicine specialists primarily to evaluate and treat pleural diseases, usually performed under conscious sedation.

Dr. Elmady from Cairo University Hospitals describes his experience in ten patients where a lung biopsy was performed. Their complication rate was significant (20% persistent air leak, 10% bleeding, 60% significant pain, etc.) for this awake procedure compared to the usual, minimal morbidity from VATS surgical thoracoscopy for lung biopsy. And the 5-mm x 4-mm diameter tissue specimen they obtained would be considered marginal at best for a definitive pathological diagnosis.

A VATS lung biopsy is a safe, quick 20-30 minute procedure under general anesthesia, with chest tube removal the following day, followed by discharge home in a very comfortable patient. Finally, most patients requiring this procedure have significantly compromised lung function (the reason for the biopsy) so that an awake, spontaneously-breathing patient can easily get into significant respiratory distress with the higher risk, medical thoracoscopic lung biopsy.

Lary Robinson, M.D., is a thoracic surgeon at the Moffitt Cancer Center in Tampa, Fla.


 

AT THE ANNUAL MEETING OF THE AMERICAN COLLEGE OF CHEST PHYSICIANS

ATLANTA – Medical thoracoscopy is safe and feasible for performing lung biopsy in patients with diffuse parenchymal lung disease of unknown etiology on high-resolution computed tomography. And the approach could serve as an alternative to surgical biopsy in some patients, findings from a prospective study suggest.

In 10 patients who underwent medical thoracoscopic lung biopsies as part of the study, good biopsy specimens, with an average size of 0.5 x 0.4 cm were obtained, Dr. Mohamed Elnady said at the annual meeting of the American College of Chest Physicians.

Complications with this advanced technique included persistent air leak for 5-7 days in two patients, pneumothorax after removal of the intercostals tube in two patients, pain in six patients, and minor bleeding in one patient. The air leaks resolved spontaneously, and the pneumothoraces resolved with administration of high flow oxygen, said Dr. Elnady of Cairo (Egypt) University Hospitals.

The mean duration of intercostal tube placement was 3.1 days, with a range of 1-7 days; no infection, respiratory failure requiring intensive care unit admission, or mortality occurred within 30 days after the procedure, he noted.

Patients in the study included four women and six men with a mean age of 42 years. The lung biopsies obtained via medical thoracoscopy were sent for histopathologic examination, and patients underwent follow-up by chest x-ray for confirmation of lung expansion, as well as observation of the intercostal tube to detect complications. Among the ultimate diagnoses were metastatic adenocarcinoma, interstitial lung disease, and lymphangioleiomyomatosis.

"Thoracosopic lung biopsy by medical thoracoscopy is useful in the diagnosis of patient with diffuse pulmonary infiltrates of unknown etiology when lung biopsy is needed for an accurate diagnosis," Dr. Elnady concluded, noting that while the procedure does carry a risk of certain non–life-threatening complications, these can be minimized with good patient selection.

Commenting on the findings, Dr. Muthiah P. Muthiah, who moderated the session, said this novel approach to obtaining a lung biopsy is of interest, but also "something we still have to get comfortable with."

"I’m not ready to do this yet, but this is something to consider ... you will want to certainly do this with a surgeon’s back-up in your institution," said Dr. Muthiah of the University of Tennessee Health Science Center, Memphis.

Neither Dr. Muthiah nor Dr. Elnady had disclosures to report.

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