Surgical Lung Biopsy Technique

Video-assisted surgical lung biopsy technique

Surgical Lung Biopsy (SLB) is indicated when the scan does not show a typical UIP pattern.

The decision to suggest a video-assisted surgical lung biopsy is on the discretion of the clinician following the multidisciplinary discussion involving pulmonologists, radiologists, and pathologists involved in ILD.

This decision must take into account:

• assessment of potential risks of the biopsy and the patients willingness to participate
• age
• comorbidities
• stage of the disease
• pulmonary function testing
• how the interstitial lung disease evolves

SLB Technique

Video thoracoscopic lung biopsy is a relatively simple surgical technique, but it requires specific involvement of the surgeon to obtain a diagnosis in the majority of cases. Morbidity associated with the operation is estimated at 7% and mortality is under 1%. Morbidity is reportedly higher in patients with IPF.

It is recommended to:

• select the site that will be biopsied using the pre-op scan
• biopsy at least 2 different lobes
• make the biopsies around 3 cm
• take the biopsy from the bases of upper lobes (posterior section of the fissure) and lower lobes (diaphragm section)
• not crush the parenchyma: “No touch technic”