The role of video-assisted thoracoscopic surgery in the diagnosis of interstitial lung disease

Keishi Sugino; Hajime Otsuka; Yusuke Matsumoto; Yasuhiko Nakamura; Keiko Matsumoto; Yoko Azuma; Takashi Makino; Akira Iyoda; Kazutoshi Shibuya; Sakae Homma

doi:10.36141/svdld.v36i2.7797

The role of video-assisted thoracoscopic surgery in the diagnosis of interstitial lung disease

Authors

Keishi Sugino Toho University Omori Medical Center
Hajime Otsuka Department of Chest Surgery, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
Yusuke Matsumoto Department of Respiratory Medicine, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
Yasuhiko Nakamura Department of Respiratory Medicine, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
Keiko Matsumoto Department of Diagnostic Radiology, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
Yoko Azuma Department of Chest Surgery, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
Takashi Makino Department of Chest Surgery, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
Akira Iyoda Department of Chest Surgery, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
Kazutoshi Shibuya Department of Pathology, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
Sakae Homma Department of Respiratory Medicine, Toho University Omori Medical Center, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan

Keywords:

Interstitial lung disease, video-assisted thoracoscopic surgery, complication, survival, multidisciplinary discussion diagnosis

Abstract

Background: When a clinical context is indeterminate for idiopathic pulmonary fibrosis (IPF), or a chest high-resolution computed tomography (HRCT) pattern is not indicative of typical or probable usual interstitial pneumonia (UIP) in patients with interstitial lung disease (ILD), surgical lung biopsy should be considered to make a confident diagnosis on the basis of multidisciplinary diagnosis (MDD). Aim: The aim of this study was to evaluate the role and safety of video-assisted thoracoscopic surgery (VATS) in patients with ILD. Methods: A total of 143 patients with ILD underwent VATS at Toho University Medical Center Omori Hospital between March 2004 and April 2017. We conducted a retrospective study on the usefulness and safety of VATS in the diagnosis of ILD under MDD. Results: The 30-day mortality was 0%. The postoperative complication rate was 12.6%, which included 5 cases of pneumothorax after discharge (3.5%), 4 cases of prolonged air leakage (2.8%), and 2 cases of acute exacerbation (1.4%). Three of 9 cases (33.3%) complicated by pneumothorax after discharge or prolonged air leakage were resected specimens of pleuroparenchymal fibroelastosis (PPFE). Two patients had acute exacerbation, who were ultimately diagnosed as having idiopathic unclassifiable IP and had histologically significant irregular dense fibrosis and numerous fibroblastic foci. The comparison between chest HRCT and histopathological findings revealed 55 cases of possible UIP [UIP (45%), NSIP (25%), and unclassifiable IP (29%)] and 21 cases of inconsistent with UIP [UIP (10%), NSIP (33%), organizing pneumonia (10%), unclassifiable IP (24%), and PPFE (24%)]. Conclusion: VATS can be safely performed to obtain a confident diagnosis for appropriate treatment strategies in patients with ILD.