Open lung biopsy in patients with diffuse pulmonary shadowing

Our plain-English summary of Open lung biopsy in patients with diffuse pulmonary shadowing, by G.E. Venn, P.H. Kay, C.J. Midwood, et al (Thorax, 1985).

The study

• Authors: G.E. Venn, P.H. Kay, C.J. Midwood, P. Goldstraw
• Journal: Thorax
• Published: 1985;40(12):931-5
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The radiological appearances of diffuse pulmonary shadowing are not specific and frequently histological examination is necessary to provide a diagnosis or assess the activity of the disease. From July 1979 to May 1983 open lung biopsy was performed in 101 patients through a limited submammary incision. Twenty seven patients had undergone prior invasive investigations and 27 were taking corticosteroids at the time of biopsy. In 92 patients the histological appearances after open lung biopsy were sufficiently specific to permit diagnosis. Respiratory tract infection occurred in six patients and in eight there was some superficial infection of the wound. These complications were more frequent in patients taking corticosteroids but the difference was not statistically significant. The chest drain was removed usually on the first postoperative day. In three critically ill patients an air leak occurred after removal of the drain, requiring formal surgical re-exploration and drainage in two cases and a brief period of intercostal drainage in the third. Four patients in the series died. All had severe pre-existing lung disease; in three open lung biopsy was performed in the late stages of severe, rapidly progressive lung disease eluding diagnosis; the fourth patient, who had massive pulmonary fibrosis from asbestos lung disease, developed a respiratory tract infection and died from progressive respiratory failure. Open lung biopsy can be performed with minimal morbidity and a high diagnostic yield. The approach used in this series provides a safe and reliable operation with good cosmetic results.

In plain English

This was a review of 101 patients with diffuse shadowing on chest X-ray who had open lung biopsy at Brompton Hospital, London, between July 1979 and May 1983. In this operation a small piece of lung is removed through a short incision under the breast. It was not a study of asbestos exposure, but asbestos lung disease was one of the diagnoses. The biopsy gave a diagnosis in 92 of the 101 patients. The most common diagnosis was cryptogenic fibrosing alveolitis (51 patients), and three patients were diagnosed with asbestos lung disease. Twenty-seven patients were taking corticosteroids. Respiratory tract infection occurred in six patients (three on steroids) and superficial wound infection in eight (four on steroids). The authors reported that these infections were more frequent in patients taking corticosteroids, but the difference was not statistically significant. Four patients died within 30 days. All had severe pre-existing lung disease. One of them had massive pulmonary fibrosis from asbestos lung disease, developed a respiratory tract infection and died from progressive respiratory failure. The authors concluded that open lung biopsy can be performed with minimal morbidity and a high diagnostic yield.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of a hospital case series of patients who had open lung biopsy by one surgical technique
• Who was studied: 101 patients (66 male, 35 female, aged 23 to 73, mean 47) with diffuse intrapulmonary shadowing who had open lung biopsy at Brompton Hospital, London, a national referral centre, from July 1979 to May 1983
• Exposure: Not an asbestos exposure study. No fiber types, jobs or doses are reported. Asbestos lung disease appears only as one of the histological diagnoses (3 cases).
• Main results:
  • Open lung biopsy yielded a diagnosis in 92 of the 101 patients. In the remaining nine the findings were not sufficient for a firm diagnosis.
  • Cryptogenic fibrosing alveolitis was the most common diagnosis (51 cases in the table)
  • Three patients were diagnosed with asbestos lung disease (table of diagnoses)
  • Of the 27 patients with prior invasive investigations, 7 already had a histological diagnosis: 4 were confirmed and 3 were amended by open lung biopsy. A diagnosis was made for the first time in 14 others, and 6 had no firm diagnosis by any method.
  • Respiratory tract infection occurred in six patients, three of whom were taking corticosteroids. Superficial wound infection occurred in eight patients, four of whom were taking steroids.
  • The authors reported that respiratory tract and wound infections were more frequent in patients taking corticosteroids, but the difference was not statistically significant (Fisher's exact test)
  • Four patients died within 30 days of open lung biopsy
  • All four patients who died had severe pre-existing lung disease
  • One of the four who died had massive pulmonary fibrosis from asbestos lung disease, developed a respiratory tract infection and died from progressive respiratory failure
• The authors' conclusion: The authors concluded that open lung biopsy can be performed with minimal morbidity and a high diagnostic yield, and that their approach provides a safe and reliable operation with good cosmetic results
• Limitations the authors state:
  • The authors noted that, because the hospital is a referral centre for chronic lung disease eluding diagnosis, the patients tended to represent the more chronic and severe end of the disease range

Topics

Medical terms in this study, explained in our Lexicon: Biopsy, Pulmonary Fibrosis.

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• Contrasting effects of alveolar macrophages and neutrophils on asbestos-induced pulmonary epithelial cell injury — D.W. Kamp, M.M. Dunn, et al. (1994)
• Pulmonary function in asbestos cement workers: a dose-response study — M. Finkelstein (1986)
• Lung sounds in asbestos induced pulmonary disorders — P. Piirilä, H. Lehtola, et al. (2000)

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