The Role of Surgical Biopsy in the Evaluation of Interstitial Lung Disease

Abstract

The clinical evaluation of a patient with suspected interstitial lung disease is complex and often requires pulmonologists to consider the use of surgical lung biopsy as an option to achieve a more definitive diagnosis. The factors that a physician needs to consider in deciding when to recommend surgical biopsy are involved, and significant variation in clinical practice exists. There are cases in which the clinical features and radiographic appearance are sufficiently characteristic of a specific disease entity to obviate the need for surgical biopsy. The limitations of a diagnostic evaluation that does not include biopsy are significant, however, and in those cases in which uncertainty exists, surgical lung biopsy should be considered. The risks associated with lung biopsy are generally low, although there is a perioperative mortality rate of approximately 5%. This is higher among patients who have a rapidly declining respiratory status or who are on mechanical ventilation at the time of biopsy. Similarly, the rate of significant perioperative morbidity is generally found to be less than 10%. The most commonly cited perioperative events include prolonged air-leak and respiratory failure requiring mechanical ventilation. The diagnostic yield of surgical lung biopsy is reported to be high; however, there is significant variation in interpretation of biopsy specimens among general and specialty pathologists and community and academic clinicians. In general, surgical lung biopsy is a necessary adjunct to the clinical evaluation of patients with interstitial lung disease when diagnostic uncertainty exists; however, the results should be interpreted carefully and in the context of the patient's entire constellation of findings.