Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Efficacy of Fluoroscopy-Guided Cutting Needle Lung Biopsy in Patients with Diffuse Infiltrative Lung Disease

미만성 침윤성 폐질환을 보이는 환자에서 방사선투시유도 절단침 폐생검의 유효성

  • Choi, Soo-Jeon (Division of Respirology, Department of Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Shin, Eun-Ah (Department of Pathology, Inje University Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Kim, Joung-Sook (Department of Health Promotion Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine)
  • 최수전 (인제대학교 의과대학 상계백병원 호흡기내과학교실) ;
  • 신은아 (인제대학교 의과대학 상계백병원 진단병리학교실) ;
  • 김정숙 (이화여자대학교 의과대학 목동병원 여성건진센터/건강증진센터)
  • Received : 2010.09.06
  • Accepted : 2010.11.23
  • Published : 2011.01.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Open lung biopsy is used for diagnosis of diffuse infiltrative lung diseases (DILD), but it is invasive and relatively expensive procedure. Fluoroscopy-guided cutting needle lung biopsy (FCNLB) has merits of avoidance of admission and rapid diagnosis. But diagnostic accuracy and safety were not well known in the diagnosis of DILD. Methods: We included 52 patients (37 men, 15 women) having DILD on HRCT with dyspnea, except the patients who could be confidently diagnosed with clinical and HRCT findings. FCNLB was performed using 16G Ace cut needle (length 1.5 cm, diameter 2 mm) at the area of most active lesion on HRCT. Final diagnoses were made by the consensus. Results: The mean interval between the HRCT and FCNLB was 4.5 days. Most cases were performed one biopsy during 5~10 minutes. Specific diagnosis was obtained in 43 of 52 biopsies (83%). The most common diagnosis was nonspecific interstitial pneumonia (11 cases) and followed by cryptogenic organizing pneumonia (7 cases), diffuse alveolar hemorrhage and usual interstitial pneumonia (5 cases in each), hypersensitivity pneumonitis (3 cases), tuberculosis and drug induced interstitial pneumonitis (2 cases in each), the others are in one respectively. Mild complication was developed in 9 patients (8 pneumothorax, 1 hemoptysis). Most of complications were regressed without treatment except one case with chest tube insertion for pneumothorax. Conclusion: Fluoroscopy-guided 16 G cutting needle lung biopsy was an useful method for the diagnosis of DILD.

Keywords

References

  1. Ferguson MK. Thoracoscopy for diagnosis of diffuse lung disease. Ann Thorac Surg 1993;56:694-6. https://doi.org/10.1016/0003-4975(93)90955-H
  2. McElvein RB. The surgical approach to interstitial lung disease. Clin Chest Med 1982;3:485-90.
  3. Arora VK, Gupta R, Johri A. Open lung biopsy in diffuse infiltrative lung disease with progressive dyspnoea: is it useful? Indian J Chest Dis Allied Sci 2002; 44:203-6.
  4. Meyer KC. The role of bronchoalveolar lavage in interstitial lung disease. Clin Chest Med 2004;25:637-49. https://doi.org/10.1016/j.ccm.2004.08.001
  5. Herf SM, Suratt PM, Arora NS. Deaths and complications associated with transbronchial lung biopsy. Am Rev Respir Dis 1977;115:708-11.
  6. Wall CP, Gaensler EA, Carrington CB, Hayes JA. Comparison of transbronchial and open biopsies in chronic infiltrative lung diseases. Am Rev Respir Dis 1981;123:280-5.
  7. Lee JH, Lee JC, Kwon JT. Surgical lung biopsy for diffuse infiltrative lung disease. Korean J Thorac Cardiovasc Surg 2006;39:844-9.
  8. Niden AH, Salem F. A safe high-yield technique for cutting needle biopsy of the lung in patients with diffuse lung disease. Chest 1997;111:1615-21. https://doi.org/10.1378/chest.111.6.1615
  9. Jang I, Kim SW, Yahang JH, Kim JW, Choi JY, Rhie S. Thoracic surgeon's role in differential diagnosis of the interstitial lung disease. Korean J Thorac Cardiovasc Surg 2006;39:382-6.
  10. Klassen KP, Andrews NC. Biopsy of diffuse pulmonary lesions. A seventeen-year experience. Ann Thorac Surg 1967;4:117-24. https://doi.org/10.1016/S0003-4975(10)66488-0
  11. Flint A, Martinez FJ, Young ML, Whyte RI, Toews GB, Lynch JP 3rd. Influence of sample number and biopsy site on the histologic diagnosis of diffuse lung disease. Ann Thorac Surg 1995;60:1605-7. https://doi.org/10.1016/0003-4975(95)00895-0
  12. Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, et al. Guidelines for radiologically guided lung biopsy. Thorax 2003;58:920-36. https://doi.org/10.1136/thorax.58.11.920
  13. Yankelevitz DF, Vazquez M, Henschke CI. Special techniques in transthoracic needle biopsy of pulmonary nodules. Radiol Clin North Am 2000;38:267-79. https://doi.org/10.1016/S0033-8389(05)70162-7
  14. Murphy JM, Gleeson FV, Flower CD. Percutaneous needle biopsy of the lung and its impact on patient management. World J Surg 2001;25:373-9. https://doi.org/10.1007/s002680020388
  15. Richardson CM, Pointon KS, Manhire AR, Macfarlane JT. Percutaneous lung biopsies: a survey of UK practice based on 5444 biopsies. Br J Radiol 2002;75:731-5.
  16. Glassberg RM, Sussman SK. Life-threatening hemorrhage due to percutaneous transthoracic intervention: importance of the internal mammary artery. AJR Am J Roentgenol 1990;154:47-9. https://doi.org/10.2214/ajr.154.1.2104724