Diagnosis Yield and Safety of Surgical Biopsy in Interstitial Lung Diseases: A Prospective Study.

Humans Prospective Studies Thoracic Surgery, Video-Assisted / adverse effects Retrospective Studies Lung Diseases, Interstitial / diagnosis Biopsy / methods Lung / pathology

Journal

The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R

Informations de publication

Date de publication:
11 2022
Historique:
received: 21 02 2021
revised: 21 07 2021
accepted: 06 08 2021
pubmed: 3 10 2021
medline: 28 10 2022
entrez: 2 10 2021
Statut: ppublish

Résumé

Surgical lung biopsy is essential in the diagnostic algorithm of interstitial lung disease (ILD) of unknown cause. Safety concerns have been recently reiterated. This study prospectively assessed the yield of diagnosis and safety of video-assisted thoracoscopic surgical lung biopsy (VATS-LB) for ILD diagnosis. This prospective study, conducted in 6 ILD-referral Paris hospitals, included 103 patients with ILD. VATS-LB was proposed after initial multidisciplinary discussion. A final diagnosis was made after the procedure, during a second multidisciplinary discussion. The main outcome was to determine the final diagnoses and their proportion after VATS-LB. Other outcomes were the percentage of change in diagnosis and treatment propositions after VATS-LB and adverse events during 3 months after the operation, postoperative pulmonary function, quality of life, and pain. A definite diagnosis was reached in 87 patients (84.4%), and 16 remained unclassifiable (15.6%). After VATS-LB, the hypothesized diagnosis changed in 65 patients (63.1%) and treatment changed in 41 patients (39.8%). One patient died of acute exacerbation. In-hospital complications were predicted by a shorter preoperative 6-minute walking test distance and by forced vital capacity lower than 77%. Postoperative quality of life was not modified at 3 months, whereas forced vital capacity decreased slightly. Postoperative neuropathic pain was revealed in 5% of patients at 1 month and in 2% at 3 months. VATS-LB dramatically changed preoperative hypothetical diagnoses and treatment in ILD of unknown cause, with good patient survival in ILD referral centers.

Sections du résumé

BACKGROUND
Surgical lung biopsy is essential in the diagnostic algorithm of interstitial lung disease (ILD) of unknown cause. Safety concerns have been recently reiterated. This study prospectively assessed the yield of diagnosis and safety of video-assisted thoracoscopic surgical lung biopsy (VATS-LB) for ILD diagnosis.
METHODS
This prospective study, conducted in 6 ILD-referral Paris hospitals, included 103 patients with ILD. VATS-LB was proposed after initial multidisciplinary discussion. A final diagnosis was made after the procedure, during a second multidisciplinary discussion. The main outcome was to determine the final diagnoses and their proportion after VATS-LB. Other outcomes were the percentage of change in diagnosis and treatment propositions after VATS-LB and adverse events during 3 months after the operation, postoperative pulmonary function, quality of life, and pain.
RESULTS
A definite diagnosis was reached in 87 patients (84.4%), and 16 remained unclassifiable (15.6%). After VATS-LB, the hypothesized diagnosis changed in 65 patients (63.1%) and treatment changed in 41 patients (39.8%). One patient died of acute exacerbation. In-hospital complications were predicted by a shorter preoperative 6-minute walking test distance and by forced vital capacity lower than 77%. Postoperative quality of life was not modified at 3 months, whereas forced vital capacity decreased slightly. Postoperative neuropathic pain was revealed in 5% of patients at 1 month and in 2% at 3 months.
CONCLUSIONS
VATS-LB dramatically changed preoperative hypothetical diagnoses and treatment in ILD of unknown cause, with good patient survival in ILD referral centers.

Identifiants

DOI: 10.1016/j.athoracsur.2021.08.056 PMID: 34599907
pubmed: 34599907
pii: S0003-4975(21)01672-6
doi: 10.1016/j.athoracsur.2021.08.056
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1911-1917

Informations de copyright

Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Auteurs

Dana Radu (D)

Chirurgie Thoracique et Vasculaire, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1272, Sorbonne Paris-Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France. Electronic address: dana.radu@aphp.fr.

Olivia Freynet (O)

Pneumologie, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1272, Sorbonne Paris-Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France.

Marianne Kambouchner (M)

Anatomopathologie, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1272, Sorbonne Paris-Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France.

Marouane Boubaya (M)

Unité de Recherche Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Sorbonne Paris-Nord, Bobigny, France.

Hilario Nunes (H)

Pneumologie, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1272, Sorbonne Paris-Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France.

Yurdagül Uzunhan (Y)

Pneumologie, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1272, Sorbonne Paris-Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France.

Pierre-Yves Brillet (PY)

Radiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Sorbonne Paris-Nord, Bobigny, France.

Patrice Guiraudet (P)

Chirurgie Thoracique et Vasculaire, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1272, Sorbonne Paris-Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France.

Mohammad Zaahid Noorah (MZ)

Anesthésie-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Sorbonne Paris-Nord, Bobigny, France.

Dominique Israël-Biet (D)

Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France.

Françoise Le Pimpec-Barthes (F)

Chirurgie Thoracique, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1138, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.

Karine Juvin (K)

Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France.

Anne Charpentier (A)

Radiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France.

Laure Gibault (L)

Anatomopathologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France.

Jalal Assouad (J)

Chirurgie Thoracique et Vasculaire, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.

Jean-Marc Naccache (JM)

Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France; Groupe Hospitalier Paris Saint Joseph, Paris, France.

Martine Antoine (M)

Anatomopathologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.

Sebastian Tavolaro (S)

Radiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.

Marco Alifano (M)

Chirurgie Thoracique, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Université de Paris, Paris, France.

Isabelle Honoré (I)

Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Université de Paris, Paris, France.

Jean Pierre L'Huillier (JP)

Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France.

Denis Debrosse (D)

Chirurgie Thoracique et Vasculaire, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.

Clairelyne Dupin (C)

Pneumologie A, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université de Paris, Paris, France.

Pauline Pradère (P)

Pneumologie A, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université de Paris, Paris, France.

Marie-Pierre Debray (MP)

Radiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université de Paris, Paris, France.

Aurélie Cazes (A)

Anatomopathologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université de Paris, Paris, France.

Pierre Mordant (P)

Chirurgie Thoracique et Vasculaire; Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université de Paris, Paris, France.

Yves Castier (Y)

Chirurgie Thoracique et Vasculaire; Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université de Paris, Paris, France.

Sadek Beloucif (S)

Anesthésie-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Sorbonne Paris-Nord, Bobigny, France.

Bruno Crestani (B)

Pneumologie A, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université de Paris, Paris, France.

Vincent Lévy (V)

Unité de Recherche Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Sorbonne Paris-Nord, Bobigny, France; Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1153, Hôpital Hôtel-Dieu, Paris, France.

Emmanuel Martinod (E)

Chirurgie Thoracique et Vasculaire, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1272, Sorbonne Paris-Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France.

Dominique Valeyre (D)

Pneumologie, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1272, Sorbonne Paris-Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France; Groupe Hospitalier Paris Saint Joseph, Paris, France.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Diagnosis Yield and Safety of Surgical Biopsy...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Diagnosis Yield and Safety of Surgical Biopsy...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie thoracique › Thoracoscopie › Chirurgie thoracique vidéoassistée › Diagnosis Yield and Safety of Surgical Biopsy...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Diagnosis Yield and Safety of Surgical Biopsy...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Maladies pulmonaires › Pneumopathies interstitielles › Diagnosis Yield and Safety of Surgical Biopsy...
questionsmedicales.fr › Techniques d'investigation › Techniques cytologiques › Cytodiagnostic › Biopsie › Diagnosis Yield and Safety of Surgical Biopsy...
questionsmedicales.fr › Appareil respiratoire › Poumon › Diagnosis Yield and Safety of Surgical Biopsy...