ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Safety of Surgical Lung Biopsy for Diagnosis of Interstitial Lung Diseases
Session Title
TP25 - TP025 SARCOIDOSIS: DIAGNOSIS, PROGNOSIS, AND TREATMENT
Abstract
A1818 - Safety of Surgical Lung Biopsy for Diagnosis of Interstitial Lung Diseases
Author Block: D. Yoo1, A. Wongkarnjana2, J. Agzarian3, Y. Shargall3, C. Finley3, W. Hanna3, A. Ayoub1, A. Aziz-ur-Rehman1, G. P. Cox1, C. J. Scallan1, K. Ask1, M. R. Kolb1, N. Hambly1; 1Department of Medicine, McMaster University, Firestone Institute for Respiratory Health, Hamilton, ON, Canada, 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 3Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada.
Rationale: Interstitial lung disease (ILD) diagnosis is dependent on interpretation of clinical, radiographic and histopathologic data in a multi-disciplinary setting. Surgical lung biopsy (SLB) remains the gold standard method of obtaining histopathologic tissue. Prior reports suggest significant morbidity and mortality associated with SLB, however, SLB may be safe and beneficial in selected patients. We report the safety, utility and morbidity of SLB among patients with ILD at a tertiary referral center in Canada. Methods: We reviewed hospital records from 2002 to 2020 for cases of SLB completed for diagnosis of ILD. Clinical, physiologic and peri-operative data were collected. Post-operative complications were recorded including mortality and acute exacerbation of ILD (AE-ILD). Results: 269 cases were identified. Mean age was 60 years and 53% of cases were men. Pre-operative pulmonary function tests showed mean FVC of 70% predicted and DLCO of 47% predicted. Median mMRC was 2. With regards to the surgical approach, 162 (66%) cases underwent video-assisted thoracic surgical (VATS) biopsy of which 30 (12%) were completed at non-elective in-patient settings. Mean hospital length of stay was 4.5 days. Post-operative complications occurred in 68 (25%) patients. 72% of complications were grades 1 or 2 according to the Thoracic Morbidity and Mortality (TMM) scoring system. AE-ILD occurred in 11 (4.3%) cases. 30-day and 90-day mortality rates were 2% and 4% respectively. Male sex, history of congestive heart failure, higher mMRC score and presence of a definite and probable UIP radiographic pattern were associated with mortality at 90-days. Of the peri-operative factors, non-elective surgery was associated with significantly worse 30-day mortality (15% vs 0.5%, p=0.001), 90-day mortality (19% vs 3%, p=0.003) and grades 3 or higher complications (56% vs 20%, p=0.009). Most common post-biopsy diagnoses were IPF (34%), hypersensitivity pneumonitis (10%), sarcoidosis (9%), cryptogenic organizing pneumonia (8%), and connective tissue disease associated ILD (7%). In 187 (76%) cases, histopathologic diagnosis altered pre-operative diagnosis or provided confirmatory diagnosis in uncertain cases. Conclusions: Surgical lung biopsy via VATS for carefully selected ILD patients is safe. Obtaining histopathologic tissue via SLB provides valuable diagnostic information which influences clinical diagnosis and subsequent patient management.
Author Block: D. Yoo1, A. Wongkarnjana2, J. Agzarian3, Y. Shargall3, C. Finley3, W. Hanna3, A. Ayoub1, A. Aziz-ur-Rehman1, G. P. Cox1, C. J. Scallan1, K. Ask1, M. R. Kolb1, N. Hambly1; 1Department of Medicine, McMaster University, Firestone Institute for Respiratory Health, Hamilton, ON, Canada, 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 3Division of Thoracic Surgery, McMaster University, Hamilton, ON, Canada.
Rationale: Interstitial lung disease (ILD) diagnosis is dependent on interpretation of clinical, radiographic and histopathologic data in a multi-disciplinary setting. Surgical lung biopsy (SLB) remains the gold standard method of obtaining histopathologic tissue. Prior reports suggest significant morbidity and mortality associated with SLB, however, SLB may be safe and beneficial in selected patients. We report the safety, utility and morbidity of SLB among patients with ILD at a tertiary referral center in Canada. Methods: We reviewed hospital records from 2002 to 2020 for cases of SLB completed for diagnosis of ILD. Clinical, physiologic and peri-operative data were collected. Post-operative complications were recorded including mortality and acute exacerbation of ILD (AE-ILD). Results: 269 cases were identified. Mean age was 60 years and 53% of cases were men. Pre-operative pulmonary function tests showed mean FVC of 70% predicted and DLCO of 47% predicted. Median mMRC was 2. With regards to the surgical approach, 162 (66%) cases underwent video-assisted thoracic surgical (VATS) biopsy of which 30 (12%) were completed at non-elective in-patient settings. Mean hospital length of stay was 4.5 days. Post-operative complications occurred in 68 (25%) patients. 72% of complications were grades 1 or 2 according to the Thoracic Morbidity and Mortality (TMM) scoring system. AE-ILD occurred in 11 (4.3%) cases. 30-day and 90-day mortality rates were 2% and 4% respectively. Male sex, history of congestive heart failure, higher mMRC score and presence of a definite and probable UIP radiographic pattern were associated with mortality at 90-days. Of the peri-operative factors, non-elective surgery was associated with significantly worse 30-day mortality (15% vs 0.5%, p=0.001), 90-day mortality (19% vs 3%, p=0.003) and grades 3 or higher complications (56% vs 20%, p=0.009). Most common post-biopsy diagnoses were IPF (34%), hypersensitivity pneumonitis (10%), sarcoidosis (9%), cryptogenic organizing pneumonia (8%), and connective tissue disease associated ILD (7%). In 187 (76%) cases, histopathologic diagnosis altered pre-operative diagnosis or provided confirmatory diagnosis in uncertain cases. Conclusions: Surgical lung biopsy via VATS for carefully selected ILD patients is safe. Obtaining histopathologic tissue via SLB provides valuable diagnostic information which influences clinical diagnosis and subsequent patient management.
