Value of Thoracoscopic Lung Biopsy in Diagnosis of Diffuse Interstitial Lung Diseases

Abstract
Background: Diffuse interstitial lung disease represent a diagnostic difficulty because the etiology is frequently uni-dentified. Lung biopsy may be necessary for the diagnosis, particularly in patients who do not suffer a well established underlying disease that comprises the lungs or have a well defined environmental exposure. Medical thoracoscopy for lung biopsy provides better inspection of the lung and allows more areas to be biopsied in contrast to the surgical biopsy that limit the choice of biopsy to the most accessible area.
Aim of the Study: To determine the diagnostic value of lung biopsy taken by thoracoscopy in diagnosis of different interstitial lung diseases.
Subjects and Methods: This study was conducted at Endoscopy Unit in Chest Department, Bab El-Sha'aria and Al-Hussin Hospitals, Al-Azhar University in the period be-tween July 2015 to September 2017. Medical thoracoscopic lung biopsy using coagulation cup forceps was performed in forty patients with diffuse lung disease that is not specified after full clinical and investigational assessment.
Results: The diagnosis was obtained in all patients 100% of cases and the distribution of pathological diagnosis among patients was as the following idiopathic pulmonary fibrosis was diagnosed in 18 patients (45%), chronic hypersensitivity pneumonitis in 6 patients (15%), sarcoidosis in 5 patients (12.5%), non-specific interstitial pneumonia in 4 patients (10%), desquamative interstitial pneumonia in three patients (5%), silicosis in tow patients (5%), and finally adenocarci-noma in tow patients (5%). The mean duration for chest tube placement after thoracoscopy was 3.7 days. There was no complications in 37 (92.5%) of patients, three patients (5%) develop surgical emphysema and only one patient (2.5%) develop empyema.
Conclusion: Medical thoracoscopy using coagulation cup forceps biopsy technique is a simple procedure that can be performed safely under local anaethesia with spontaneous ventilation for diagnosis of diffuse interstitial lung diseases that remain undiagnosed after extensive investigations.