A standardized technique for lung biopsy in idiopathic interstitial pneumonias

Objective. In cases of suspected idiopathic interstitial pneumonia, a surgical lung biopsy can be necessary to obtain a definitive diagnosis. The optimal site, size and specimen number to ensure adequate sampling remain controversial. We developed a standardized technique to perform surgical lung biopsy. Methods. Patients with preoperative suspicion of IIP were evaluated for this kind of operation. When diffuse, bilateral and uniformly distributed abnormalities were seen at high-resolution computed-tomography the patient underwent this operation. Three pulmonary segments of the left lung (lingula, lateral/posterior basal and apical segment of the lower lobe) were biopsied using a three-ports videothoracoscopic approach. The operation was conducted under general anaesthesia and double-lumen endotracheal intubation for single-lung ventilation. No frozen examination nor microbiological examination were routinely requested. Results. Fifty-nine patients were operated using this technique. No conversions from VATS to thoracotomy were necessary. The mean operative time was 38 minutes. Mortality was 3.3%. A firm clinicopathological diagnosis was achieved in all patients. Conclusions. The proposed technique has been proved to have a high diagnostic yield and to be safe, simple and fast in the various form of idiopathic interstitial pneumonias. Conversely, the technique is not indicated in diffuse parenchymal lung diseases in which the distribution of the lesions at HRCT is non-uniform and inhomogeneous. In these cases the various distribution of pathological changes requires a case-by-case evaluation of the optimal site, size and number of biopsies.