PATHOLOGICAL COMPARISON OF VIDEO-ASSISTED THORACIC SURGICAL LUNG-BIOPSY WITH TRADITIONAL OPEN LUNG-BIOPSY

Video-assisted thoracic surgical lung biopsy is an alternative to trad itional open lung biopsy for diagnosis in patients with pleuropulmonar y diseases. Between January 7, 1991, and August 3, 1993, 71 consecutiv e patients had video-assisted thoracic surgical lung biopsy and 42 pat ients had traditional open lung biopsy. A specific histologic diagnosi s that correlated with the clinical findings was sought in each case a nd the yield was compared between the two groups. Procedure-related ar tifactual changes were also evaluated; the extent of traumatic hemorrh age and neutrophil margination as a result of tissue manipulation was significantly greater for patients in the video-assisted thoracic surg ical lung biopsy group than for those in the open lung biopsy group, b ut the changes were generally minor and did not affect diagnostic yiel d. Complications developed in 11 (15%) of 71 patients in the video-ass isted thoracic surgical lung biopsy group including 5 patients with pr olonged air leakage (more than 10 days); 2 with pneunonia; and 1 each with bleeding, late pneumothorax necessitating readmission, mucus plug necessitating bronchoscopy, and a hypoxic episode necessitating mecha nical ventilation. On the other hand, 7 (17%) of 42 patients in the op en lung biopsy group had complications including 4 patients with prolo nged air leakage (more than 10 days) and 3 with pneumonia. There were 6 (8%) operative deaths in patients who had video-assisted thoracic su rgical lung biopsy and 7 (17%) in the open lung biopsy group; all bah preoperative respiratory failure. We conclude that video-assisted thor acic surgical lung biopsy is an acceptable alternative to open lung bi opsy for diagnosis of pulmonary infiltrates or indeterminate nodules.