THE ROLE OF THORACOSCOPY IN THE DIAGNOSIS OF INTERSTITIAL LUNG-DISEASE

A study was undertaken to evaluate the safety and efficacy of thoracos copic lung biopsy for interstitial lung disease. The relation between operative findings, pathologic findings, and preoperative computed tom ographic scan findings was examined. Twenty-six patients, 10 male and 16 female, underwent thoracoscopic lung resection to diagnose intersti tial lung disease. Sixteen patients were outpatients for an elective p rocedure; 10 were inpatients including 2 who were ventilator dependent . The mean length of operation was 54 minutes and the mean length of c hest tube duration, 1.3 days. There were no deaths. Staphylococcal pne umonia developed in 1 patient postoperatively. One patient with system ic pulmonary hypertension was ventilator dependent for 48 hours. A dou ble-lumen endotracheal tube was used in all but 2 patients. Twelve-mil limeter trocar ports were used to allow easy interchange of staplers a nd endoscopic instruments. Biopsy of at least two lobes was performed in each patient with resection of a piece of grossly abnormal lung. A single chest tube was left routinely. The pathologic diagnosis was usu al interstitial pneumonitis in 7 patients. four patients had interstit ial fibrosis and 4, granulomas. Three patients had diffuse alveolar da mage and 3, Wegener's granulomatosis. Two patients had bronchiolitis o bliterans with organizing pneumonia. One patient each had lymphangiole iomyomatosis, eosinophilic granuloma, and cytomegalovirus. Sixteen pat ients underwent preoperative computed tomographic scanning. The scans were assessed by 2 radiologists who were blinded to the surgical resul ts. Computed tomography accurately predicted the site of disease in mo st instances. Four patients had at least one lobe with no evidence of disease on computed tomography but with interstitial lung disease foun d at thoracoscopy. One of these patients had no evidence of disease on computed tomographic scans. Thoracoscopy allows selective biopsy of m ultiple lung segments, thereby increasing the diagnostic yield in inte rstitial lung disease.