Mortality after surgical lung biopsy for the evaluation of interstitial lung diseases

Interstitial lung diseases (ILD) represent a heterogeneous group of disorders in which the aetiology, not infrequently, remain unknown. Specific ILD requires a multi-disciplinary approach (MDD), in expert reference centers for diffuse parenchymal lung diseases (DPLD), using a stepwise approach which sometimes ends with the request of tissue sampling. The standard procedure to obtain histology in undefined ILD is the surgical lung biopsy (SLB) via video-thoracoscopy (VATS). However, SLB is associated with significant postoperative morbidity and mortality, and the physician must weigh carefully risks and benefits when a SLB is considered. VATS lung biopsy appears to be safer than open biopsy with an associated 90-day mortality that is somewhat lower, but not negligible, at approximately 3.4%. Last but not least, higher mortality risk may occur in patients whose ultimate diagnosis is idiopathic pulmonary fibrosis (IPF), as SLB in patients with IPF may trigger an acute exacerbation of IPF. Confirming the diagnosis and differentiating among specific forms of ILDs may though not be possible without performing SLB. Newer techniques, such as uniportal VATS under thoracic epidural anesthesia or intercostals block or transbronchial cryobiopsy may increase the safety of tissue sampling in undefined ILD patients.