Thoracoscopy versus open lung biopsy in the diagnosis of interstitial lungdisease: a randomised controlled trial

Background: Some patients with diffuse lung disease require a lung biopsy f or diagnosis. This study is aimed to compare the clinical results and the e fficacy of video-assisted thoracoscopic lung biopsy with the open lung biop sy method for the diagnosis of interstitial lung disease. From January 1996 to December 1998, 61 patients were referred for diagnostic lung biopsy. Th irty two patients were randomly allocated to have a thoracoscopic lung biop sy and twenty nine had an open lung biopsy. Subsequently, various factors w ere analyzed and compared in both groups. Results: There was no difference between the groups in age and pulmonary function test. Median operative tim e was 45 minutes for the thoracoscopic biopsies and 60 minutes for the open biopsies (P=0.009). Median amount of analgesia (Demerol) in the first 24 h ours postoperatively was 75 mg. for thoracoscopic biopsies and 150 mg. for open biopsies (P<0.001), Median duration of insertion of a chest tube in da ys and 24 hours of pleural drainage was mot statistically significant betwe en the two groups. Duration of hospital stay was significantly less for the thoracoscopic biopsy (3 days) compared with an open biopsy (5 days) (P<0.0 01). The diagnostic yield of each method was comparable (thoracoscopic biop sy 31/32; open biopsy 27/29) (P = 0.3), Complications occurred in 6/29 of p atients undergoing open biopsies and 3/32 patients undergoing thoracoscopic lung biopsies (p=0.28). There were 2 deaths among patients who had an open lung biopsy. Conclusion Thoracoscopic lung biopsy has some clinical advant ages over open biopsy. These findings suggest that thoracoscopic lung biops y is an acceptable alternative to open lung biopsy for the diagnosis of dif fuse interstitial lung diseases.