Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지

Safety and Significance of Surgical Lung Biopsy for Interstitial Lung Disease

간질성 폐질환에 대한 수술적 폐생검의 의의 및 안전성

  • Lee, Yu Jin (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Joung, Mi Kyong (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Chung, Chae Uk (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Park, Ji Won (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Shin, Ji Young (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Jung, Sun Young (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Lee, Jeong Eun (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Park, Hee Sun (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Jung, Sung Soo (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Kim, Ju Ock (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Kim, Sun Young (Department of Internal Medicine, College of Medicine, Chungnam National University)
  • 이유진 (충남대학교 의과대학 내과학 교실) ;
  • 정미경 (충남대학교 의과대학 내과학 교실) ;
  • 정재욱 (충남대학교 의과대학 내과학 교실) ;
  • 박지원 (충남대학교 의과대학 내과학 교실) ;
  • 신지영 (충남대학교 의과대학 내과학 교실) ;
  • 정선영 (충남대학교 의과대학 내과학 교실) ;
  • 이정은 (충남대학교 의과대학 내과학 교실) ;
  • 박희선 (충남대학교 의과대학 내과학 교실) ;
  • 정성수 (충남대학교 의과대학 내과학 교실) ;
  • 김주옥 (충남대학교 의과대학 내과학 교실) ;
  • 김선영 (충남대학교 의과대학 내과학 교실)
  • Received : 2007.04.20
  • Accepted : 2007.05.30
  • Published : 2007.07.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Surgical lung biopsy is required to establish the etiology and stage of interstitial lung disease(ILD). and this procedure can be safe and meaningful for making clinical decisions. We wanted to determine the safety of surgical lung biopsy(SLB) in patients with interstitial lung disease(ILD). Methods: We conducted a retrospective review of 40 patients with suspected ILD and they underwent surgical lung biopsy from January 2001 to June 2006 at Chungnam University Hospital. We analyzed retrospectively according to their age, gender, pulmonary function, chest tube duration, the arterial blood gases, the procedural technique, and the requirement for supplemental oxygen and mechanical ventilation(MV) at the time of SLB. Results: The mean age of the patients was 56.4${\pm}$16.13 years(range: 21 to 77 years). Overall, the 30-day and 90-day mortality rates were 15% and 20%, respectively. The predictors of perioperative mortality were either the need for mechanical ventilation(MV) at the time of SLB or the need for supplemental oxygen prior to undergoing SLB. Among the 32 patients who were 90-day survivors, the proportion of those patients using the oxygen supplement was 28.1% (n=9). All 8 patients who were 90-day non-survivors used oxygen supplement (p=0.000). The use of the MV was 12.5% (n=4) in the 90-day survivors (n=32) and 62.5% (n=5) in the 90-day non-survivors (n=8); there was a significant difference between the 90-day survivors and non-survivors (p=0.000). Conclusion: Patients who require MV and supplemental oxygen are associated with an increased risk for death following SLB.

연구배경: 수술적 폐생검은 간질성 폐질환의 확진 및 환자의 치료와 예후 예측에 도움을 주며, 안전하게 시행할 수 있는 방법이다. 간질성 폐질환의 확진을 위해 수술적 폐생검을 한 환자들을 분석하여, 간질성 폐질환 환자에 있어서 수술적 폐생검의 안전성 및 의의를 규명하고자 한다. 방 법: 2001년 1월부터 2006년 6월까지 충남대학교 병원에서 간질성 폐질환이 의심되어 확진을 위해서 수술적 폐생검을 시행 받은 70예 중, 간질성 폐질환으로 진단된 40명의 환자를 후향적으로 분석하였다. 결 과: 연령 분포는 21세에서 77세까지로 평균은 56.4${\pm}$16.1세이며, 총 40명의 환자 중 28명(70%)은 최소 개흉술을 시행하였고, 12명(30%)은 흉강경으로 폐조직 검사를 시행하였다. 수술적 폐생검 후 30일 전체 사망률과 90일 전체 사망률은 각각 15%와 20%이였다. 수술 후 90일 사망자(8명)와 생존자(32명)를 비교해 보면, 수술 전 추가적인 산소 요법이 필요했던 경우는 술후 90일 사망자가 100%(8명)이고, 생존자가 28.1%(9명)이었으며 (p=0.000), 수술 전 기계적 환기요법을 하였던 경우는 술후 90일 사망자가 62.5%(5명)이고, 생존자가 12.5%(4명)으로 (p=0.000) 수술 후 사망률과 통계적 유의성을 보였다. 결 론: 수술적 폐생검은 간질성 폐질환이 의심되는 환자 중에서 산소 공급을 하고 있거나, 기계적 환기 요법을 하고 있는 경우 술후 사망할 위험도가 높기 때문에, 임상에서 수술적 폐생검이 환자의 치료 및 예후에 어떤 영향을 미칠지 신중하게 생각하고 결정해야 한다.

Keywords

References

  1. Raghu G. Interstitial lung disease: a diagnostic approach. Are CT scan and lung biopsy indicated in every patient? Am J Respir Crit Care Med 1995;151:909-14 https://doi.org/10.1164/ajrccm/151.3_Pt_1.909
  2. American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias: This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med 2002;165:277-304 https://doi.org/10.1164/ajrccm.165.2.ats01
  3. Hunninghake GW, Lynch DA, Galvin JR, Gross BH, Muller N, Schwartz DA, et al. Radiologic findings are strongly associated with a pathologic diagnosis of usual interstitial pneumonia. Chest 2003;124:1215-23 https://doi.org/10.1378/chest.124.4.1215
  4. Raghu G, Mageto YN, Lockhart D, Schmidt RA, Wood DE, Godwin JD. The accuracy of the clinical diagnosis of new-onset idiopathic pulmonary fibrosis and other interstitial lung disease: a prospective study. Chest 1999;116:1168-74 https://doi.org/10.1378/chest.116.5.1168
  5. Popper HH. Which biopsies in diffuse infiltrative lung diseases and when are these necessary? Monaldi Arch Chest Dis 2001;56:446-52
  6. Kramer MR, Berkman N, Mintz B, Godfrey S, Saute M, Amir G. The role of open lung biopsy in the management and outcome of patients with diffuse lung disease. Ann Thorac Surg 1998;65:198-202 https://doi.org/10.1016/S0003-4975(97)01081-3
  7. Mouroux J, Clary-Meinesz C, Padovani B, Perrin C, Rotomondo C, Chavaillon JM, et al. Efficacy and safety of videothoracoscopic lung biopsy in the diagnosis of interstitial lung disease. Eur J Cardiothorac Surg 1997;11:22-4 https://doi.org/10.1016/S1010-7940(96)01007-X
  8. Crystal RG, Gadek JE, Ferrans VJ, Fulmer JD, Line BR, Hunninghake GW. Interstitial lung disease: current concepts of pathogenesis, staging and therapy. Am J Med 1981;70:542-68 https://doi.org/10.1016/0002-9343(81)90577-5
  9. Shim YS. Recent advances in diffuse interstitial lung disease. Tuberc Respir Dis 1989;36:193-207
  10. Zompatori M, Bna C, Poletti V, Spaggiari E, Ormitti F, Calabro E, et al. Diagnostic imaging of diffuse infiltrative disease of the lung. Respiration 2004;66 71:4-19
  11. Wilcox AG. Advances in radiology for interstitial lung disease. Curr Opin Pulm Med 1999;5:278-83 https://doi.org/10.1097/00063198-199909000-00002
  12. Catterall JR, McCabe RE, Brooks RG, Remington JS. Open lung biopsy in patients with Hodgkin's disease and pulmonary infiltrates. Am Rev Respir Dis 1989; 139:1274-9 https://doi.org/10.1164/ajrccm/139.5.1274
  13. Ferson PF, Landreneau RJ, Dowling RD, Hazelrigg SR, Ritter P, Nunchuck S, et al. Comparison of open versus thoracoscopic lung biopsy for diffuse infiltrative pulmonary disease. J Thorac Cardiovasc Surg 1993;106:194-9
  14. Warner DO, Warner MA, Divertie MB. Open lung biopsy in patients with diffuse pulmonary infiltrates and acute respiratory failure. Am Rev Respir Dis 1988;137:90-4 https://doi.org/10.1164/ajrccm/137.1.90
  15. Bensard DD, Mclntyre RC Jr, Waring BJ, Simon JS. Comparison of video thoracoscopic lung biopsy to open lung biopsy in the diagnosis of interstitial lung disease. Chest 1993;103:765-70 https://doi.org/10.1378/chest.103.3.765
  16. Carnochan FM, Walker WS, Cameron EW. Efficacy of video assisted thoracoscopic lung biopsy: an historical comparison with open lung biopsy. Thorx 1994;49:361-3 https://doi.org/10.1136/thx.49.4.361
  17. Krasna MJ, White CS, Aisner SC, Templeton PA, McLaughlin JS. The role of thoracoscopy in the diagnosis of interstitial lung disease. Ann Thorac Surg 1995;59:348-51 https://doi.org/10.1016/0003-4975(94)00844-W
  18. Flabouris A, Myburgh J. The utility of open lung biopsy in patients requiring mechanical ventilation. Chest 1999;115:811-7 https://doi.org/10.1378/chest.115.3.811