Highlights
- •Conventional VATS is the standard procedure for ILD patients requiring a histologic confirmation of their diagnosis.
- •Awake” VATS biopsy has emerged as a potential alternative to conventional VATS in patients with ILD.
- •Specimens obtained via “awake” VATS are similar to those obtained via conventional VATS.
- •In ILD patients, pathologic features and diagnostic confidence do not differ between conventional and “awake” VATS biopsy.
Abstract
Surgical lung biopsy remains the standard procedure for the subset of patients with
fibrosing interstitial lung disease (F-ILD) who require a lung biopsy to secure a
confident diagnosis. Little is known about the pathologic features of samples obtained
via non-intubated/“awake” surgical lung biopsy and the diagnostic accuracy of awake
biopsy in patients with F-ILD. Two expert thoracic pathologists blinded to the type
of lung biopsy compared the clinical-pathologic features of 120 conventional VATS
biopsies with those of 21 consecutive non-intubated/“awake” VATS biopsies. No statistically
significant differences between the two procedures were observed with regard to identification
of histopathological features. Biopsy length, average of sampled lobes and mean number
of slides were similar with the two procedures, while the width of the biopsies was
significantly deeper with conventional VATS (31.5 mm versus 25.6 mm; p = 0.01). By
contrast, the mean age of patients (69.5 versus 64.5 years; p = 0.02) and the level
of diagnostic confidence (100% versus 75%; p = 0.007) were significantly higher among
patients undergoing the “awake” procedure. Diagnostic yield was 100% in both groups,
with a similar distribution of ILD diagnoses. Non-intubated/“awake” biopsy has the
potential to become the standard surgical procedure in patients with F-ILD requiring
a histological confirmation of their diagnosis. However, larger prospective studies
are needed to validate the safety and diagnostic yield of “awake” compared to conventional
VATS.
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Article info
Publication history
Published online: February 22, 2022
Accepted:
February 16,
2022
Received in revised form:
February 15,
2022
Received:
September 20,
2021
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
