Efficacy and safety of lung biopsy via mini-thoracoscopy in interstitial lung diseases

Introduction Histopathological examination of interstitial lung diseases is important to assist diagnosis when the results of clinical assessment, laboratory investigations, high-resolution computed tomographic imaging, and pulmonary function testing do not allow making a confident diagnosis of a certain type or stage of interstitial lung disease. Patients and methods A total of 20 patients were enrolled in the study at Chest Medicine Department, Mansoura University Hospital, Mansoura, Egypt. A written informed consent for thoracoscope and tissue sampling was obtained from all patients. The patients were divided into two groups: group I underwent medical thoracoscope and group II underwent mini-thoracoscope. Results The biopsy size ranges from 3 to 9 mm, with a mean±SD of 6.2±1.4 mm in group I and 3.9±0.88 mm in group II. Fever was common in group I (50%) than group II (20%). Surgical emphysema was higher in group I, with a median (range) of 3 (2-3) and median (range) in group II was 1 (1-2). Bleeding was reported in most cases for each group, with median (range) of 1.5 (1-2) in group I and 1 (0-1) in group II. No cases were complicated with severe bleeding in both groups. Pain scoring was higher in group I with median (range) of 2 (0-3) and 1 (1-2) in group II. Only two cases in group I were complicated with persistent air leak more than or equal to 7 days. There is a statistically significant difference regarding bleeding, pain, and surgical emphysema (P=0.010, 0.044, 0.013). Diagnostic yield is 100% in both groups. Nonspecific interstitial pneumonia was the most common diagnosis in group I (40%) and in group II (60%), followed by usual interstitial pneumonia in three (30%) cases in group I and four (40%) cases in group II. The least common diagnosis is broncholites obliterans organising pneumonia (BOOP), pulmonary alveolar proteinosis (PAP), and mucoid adenocarcinoma, which were encountered in 10% each in group I. Conclusion Lung biopsy can be performed with less invasive maneuver by mini-thoracoscopy, leading to decrease complications with good diagnostics.