Descriptive study of open lung biopsies at the Hospital Universitario San Ignacio

Estudio descriptivo de biopsias pulmonares a cielo abierto en el Hospital Universitario San Ignacio

Introduction: open lung biopsy is a very valuable instrument for establishing the etiology of lung diseases in cases where diagnosis cannot be reached by means of less invasive tests. It provides conclusive diagnosis in cases of suspected neoplasms, infections, and interstitial lung diseases, especially in the group of patients in whom less invasive procedures such as tomography-guided transbronchial or percutaneous biopsies have not been conclusive.

Materials and Methods: a retrospective, descriptive, observational study was carried out, which included all adult patients taken to open lung biopsy over the period from January 2007 to December 2011; the data was obtained from a database in which surgical procedures performed by the Thoracic Surgery group during that period are registered. The medical diagnosis reported in the clinical record was identified and compared with the histopathological report in order to assess whether there were changes in the diagnosis, prognosis, or treatment of the patient. Results: 326 patients were taken to open lung biopsy during the study period. The most common diagnoses reached by biopsy were: lung cancer 12%, lung metastasis 8%, organizing pneumonia 9%, granulomas 8%, anthracosis 7%, bullae 6%, and lung infections 9%. In the group of patients with pre-surgical clinical suspicion of malignancy, suspected neoplasm was confirmed in 107 (86%), and benign disease was reported in 16 (13%) of the remaining cases; in the group of patients with suspected infectious disease, diagnosis was reached by biopsy in 28 (49%) of 57 subjects. The mortality rate was 8,5%; most fatalities were related to the subject’s baseline condition: severe pneumonia, empyema, or multiple organ failure, and the surgical procedure was not to be considered accountable. After the histopathological report of the open lung biopsy specimen, the diagnosis or management was changed in 87% of the cases, which represents a yield much greater than that reported in the literature, which ranges from 18% to 65%.

Conclusions: open lung biopsy is a procedure whose rate of complications and mortality is low, while its diagnostic yield is high. This makes it a very valuable element for diagnosing pulmonary diseases, especially in the group of interstitial lung diseases, suspected neoplasm, and immunocompromised cases where opportunistic infection is suspected.