• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.5-19
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• 1998

Introduction: Direct histologic and bacteriologic examination of a representative specimen of lung tissue is the only certain method of providing an accurate diagnosis in various pulmonary diseases including diffuse pulmonary diseases. The purpose of national survey was to define the indication, incidence, effectiveness, safety and complication of open and thoracoscopic lung biopsy in korea. Methods: A multicenter registry of 37 university or general hospitals equipped more than 400 patient's bed were retrospectively collected and analyzed for 3 years from the January 1994 to December 1996 using the same registry protocol. Results: 1) There were 511 cases from the 37 hospitals during 3 years. The mean age was 50.2 years(${\pm}15.1$ years) and men was more prevalent than women(54.9% vs 45.9%). 2) The open lung biopsy was performed in 313 cases(62%) and thoracoscopic lung biopsy was performed in 192 cases(38%). The incidence of lung biopsy was more higher in diffuse lung disease(305 cases, 59.7%) than in localized lung disease(206 cases, 40.3%) 3) The duration after abnormalities was found in chest X-ray until lung biopsy was 82.4 days(open lung biopsy: 72.8 days, thoracoscopic lung biopsy: 99.4 days). The bronchoscopy was performed in 272 cases(53.2%), bronchoalveolar lavage was performed in 123 cases(24.1%) and percutaneous lung biopsy was performed in 72 cases(14.1%) before open or thoracoscopic lung biopsy. 4) There were 230 cases(45.0%) of interstitial lung disease, 133 cases(26.0%) of thoracic malignancies, 118 cases(23.1%) of infectious lung disease including tuberculosis and 30 cases (5.9 %) of other lung diseases including congenital anomalies. No significant differences were noted in diagnostic rate and disease characteristics between open lung biopsy and thoracoscopic lung biopsy. 5) The final diagnosis through an open or thoracoscopic lung biopsy was as same as the presumptive diagnosis before the biopsy in 302 cases(59.2%). The identical diagnostic rate was 66.5% in interstitial lung diseases, 58.7% in thoracic malignancies, 32.7% in lung infections, 55.1 % in pulmonary tuberculosis, 62.5% in other lung diseases including congenital anomalies. 6) One days after lung biopsy, $PaCO_2$ was increased from the prebiopsy level of $38.9{\pm}5.8mmHg$ to the $40.2{\pm}7.1mmHg$(P<0.05) and $PaO_2/FiO_2$ was decreased from the prebiopsy level of $380.3{\pm}109.3mmHg$ to the $339.2{\pm}138.2mmHg$(P=0.01). 7) There was a 10.1 % of complication after lung biopsy. The complication rate in open lung biopsy was much higher than in thoracoscopic lung biopsy(12.4% vs 5.8%, P<0.05). The incidence of complication was pneumothorax(23 cases, 4.6%), hemothorax(7 cases, 1.4%), death(6 cases, 1.2%) and others(15 cases, 2.9%). 8) The 5 cases of death due to lung biopsy were associated with open lung biopsy and one fatal case did not describe the method of lung biopsy. The underlying disease was 3 cases of thoracic malignancies(2 cases of bronchoalveolar cell cancer and one malignant mesothelioma), 2 cases of metastatic lung cancer, and one interstitial lung disease. The duration between open lung biopsy and death was $15.5{\pm}9.9$ days. 9) Despite the lung biopsy, 19 cases (3.7%) could not diagnosed. These findings were caused by biopsy was taken other than target lesion(5 cases), too small size to interpretate(3 cases), pathologic inability(11 cases). 10) The contribution of open or thoracoscopic lung biopsy to the final diagnosis was defininitely helpful(334 cases, 66.5%), moderately helpful(140 cases, 27.9%), not helpful or impossible to judge(28 cases, 5.6%). Overall, open or thoracoscopic lung biopsy were helpful to diagnose the lung lesion in 94.4 % of total cases. Conclusions: The open or thoracoscopic lung biopsy were relatively safe and reliable diagnostic method of lung lesion which could not diagnosed by other diagnostic approaches such as bronchoscopy. We recommend the thoracoscopic lung biopsy when the patients were in critical condition because the thoracoscopic biopsy was more safe and have equal diagnostic results compared with the open lung biopsy.

• Journal of Chest Surgery
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• v.29 no.7
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• pp.741-746
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• 1996

Diffuse interstitial lung disease due to a wide variety of conditions are amenable to diagnosis by means of clinical evaluation, bronchoalveolar lavage, transbronchial biopsy and lung biopsy. The recently introduced technique of thoracoscopic wedge biopsy provides the potential advantages of greater selection of biopsy site and reduced postoperative chest pain compared with the standard open lung biopsy Video assisted thoracoscopic lung biopsy was performed in twenty patients for diagnosis of diffuse in- terstitial lung disease during the period from January 1993 to June 1994. The ages of the patients ranged from 18 to 69 years(mean 48.5 years), and the patients consisted of 10 males and 10 females. In all twenty, thoracoscpic lung biopsy samples were obtained; 9 from left lower lobe, 7 from right lower lobe, 2 from right upper lobe, 1 from left upper lobe, and 1 from right middle lobe. All patients were correctly diagnosed. The two common diseases were usual in erstitial pneumonia(UIP)(8120) and mil- liary tuberculo si s(4120) . Mean duration of the chest drainage was 3.2 days. There was no complication.

• Journal of Chest Surgery
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• v.32 no.2
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• pp.164-170
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• 1999

Background: The diffuse infiltrative lung disease often requires biopsy for its final diagnosis. Unlike the limited exposure that can be achieved through small thoracotomy incisions in open lung biopsy technique, the thoracoscopic approach allows visualization and biopsy of nearly entire surface of the lung without morbidity of large standard thoracotomy. The purpose of this study was to compare the diagnostic efficacy and operative safety of thoracoscopic lung biopsy(TLB) with open lung biopsy(OLB) in the diagnosis of diffuse infiltrative lung disease. Material and Method: From March 1993 to August 1997, 81 patients were referred for diagnostic lung biopsy. 51 of them underwent standard open lung biopsy and the remaining 30 patients underwent thoracoscopic lung biopsy. Result: Mean operative time was 63 minutes for TLB and 79 minutes for OLB (p=0.04). The volume of biopsy specimen was not different between two groups(TLB 7.8 cm3, OLB 6.9 cm3 : p=0.72) and the diagnostic accuracy of each methods was comparable (TLB 100%, OLB 96%). The duration of hospital stay was significantly less in TLB (TLB 13days, OLB 22days : p=0.01). The duration of parenteral narcotics administration was also less for TLB(TLB 2.5days, OLB 5.2days, p=0.05). Meanwhile, the duration of chest tube drainage, the frequency of parenteral narcotic injection were not significantly different between two groups. Complications occurred in 2 among the TLB patients (6.67%) and 4 among the OLB patients (7.84%). There was no operative mortality in both groups. Conclusion: We concluded that TLB is a good alternative procedure to OLB in the diagnosis of diffuse infiltrative lung disease with lower morbidity and comparable diagnostic accuracy.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1232-1236
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• 1997

Diffuse lung disease is amenable to diagnosis by means of clinical evaluation, bronchoalveolar lavage, transbronchial biopsy, and lung biopsy. The recently introduced technique of thoracoscopic wedge biopsy provides the potential advantages of greater selection of biopsy sites and reduced postoperative pain compared with those associated with standard open lung biopsy. Video assisted thoracoscopic lung biopsy was performed in 22 patients for the diagnosis of diffuse lung disease during the period from August 1994 to December 1996, and the following results were obtained: 1. The patients were 14 men and 8 women. The average age was 54.6 years. 2. 13 lung biopsy specimens were obtained from the right lower lobe, 4 from he right upper lobe, 3 from the right middle lobe, 3 from the left upper lobe, and 3 from the left lower lobe. 3. A comparison of pulmonary function tests between preoperative and postoperative values showed no significant differences in FVC, FEVI, and FEVl/FVC(p>0.05). All patients were pathologically diagnosed and the most common disease was usual interstitial pneumonia(8/22). In conclusion, thoracoscopic lung biopsy was a safe and effective diagnostic method of diffuse lung disease.

• Journal of Chest Surgery
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• v.46 no.4
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• pp.316-318
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• 2013

Thoracoscopic needle aspiration is a good alternative for a centrally-located solitary pulmonary nodule (SPN) suspected of being lung cancer without severe pleural adhesion. The authors report the technique of thoracoscopic needle aspiration biopsy in a SPN just in the medial aspect of the truncus anterior pulmonary artery and the right upper lobe bronchus.

• Tuberculosis and Respiratory Diseases
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• v.39 no.3
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• pp.271-277
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• 1992

Diffuse panbronchiollitis (DPB), a rare progressive disorder, has lately been receiving increasing attention. DPB is a disease of obscure etiology, characterized by chronic inflammation localized mainly in the region of respiratory bronchiole just distal to the terminal bronchioles. In 1983, Homma and coworkers reported 82 cases of a new clinicopathological entity, DPB, in Japan. Also DPB is a disease largely restricted geographically to Japan but the prevalence in other countries is extremely low. Histoloically, it is characterized by a suppurative bronchiolitis involving primarily the respiratory and terminal bronchioles with subsequent progression to bronchiectasis. The disease progresses rapidly and results in respiratory failure due to repeated respiratory infections. We experienced a cases of DPB accompanied with chronic maxillary sinusitis in both sinuses. Diagnosis of DPB was comfirmed by pathological results from thoracoscopic lung biopsy, typical radiological findings, clinical symptoms and pulmonary function test. After treatment with erythromycin for 6 months, the patient's condition and the typical micronodular densities on the chest radiography improved. A few case of DPB was reported in Korea. We report a case of DPB through thoracoscopic lung biopsy.

• Journal of Chest Surgery
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• v.39 no.11 s.268
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• pp.844-849
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• 2006

Background: The diffuse infiltrative lung disease requires surgical lung biopsy for its final diagnosis. We evaluated the effect of surgical lung biopsy for final diagnosis of duffuse interstitial lung disease and compared video assisted thoracoscopic lung biopsy(TLB) with open lung biopsy(OLB). Material and Method: We evaluated the patients who underwent surgical lung biopsy from March 2000 from December 2005, retrospectively, We divide to two groups(OLB and TLB group) and compared them. Result: There were 36 patients and cough was the most common pre- operative symptom. Surgery time, anesthetic time, hospital stay, duration of chest tube indwelling, specimen volume and the rate of post-operative complication were not significantly different between two groups. Histologic diagnosis was confirmed in all cases. There was one post-operative death who had suffered from respiratory failure since pre-operative period. Conclusion: Surgical lung biopsy is effective method in final diagnosis for diffuse infiltrative lung disease. Video assisted thoracoscopic lung biopsy is lesser invasive method than open lung biopsy and provide similar results, so it is basic diagnostic method of surgical lung biopsy.

• Tuberculosis and Respiratory Diseases
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• v.72 no.2
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• pp.223-227
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• 2012

Pulmonary siderosis, or Welder's lung disease is an occupational lung disease caused by iron-inhalation. Diagnosis of pulmonary siderosis is based on occupational history of the patient, radiologic findings, and pathologic findings of iron-laden macrophages within lung tissue or broncho-alveolar lavage fluid. We observed a case of a 43 years-old welder diagnosed with pulmonary siderosis via thoracoscopic lung biopsy. Sputum culture along with pathology also identified a non-tuberculotic mycobacterial infection with a sputum culture and the pathologic findings. The patient was treated with anti-tubercular medication and cessation of iron-exposure. And his condition improved within a few months.

• Korean Journal of Bronchoesophagology
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• v.6 no.2
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• pp.159-163
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• 2000

The patient with findings of diffuse infiltrative lung on chest X-ray has various causes; therefore, the prognosis is different and the treatment should be changed according to the cause. We are trying to identify the meaning of operative lung biopsy and to 11nd a more accurate and effective procedure. We reviewed 46 medical records of patients with the findings of diffuse infiltrative lung on chest X-ray who had undergone operative lung biopsy or biopsies for 8 years. The open lung biopsy were done in 22 cases(47.8%) and thoracoscopic lung biopsy in 24 cases(52.2%). There is no significant difference in the rate of diagnosis(p=0.452) and the incidence of complications(p=0.155) between these groups. The number of cases with more than two biopsies are 9(19.6%) and that of one biopsy are 37(80.4%). There are no statistical difference in the rate of diagnosis(p=0.928) and the incidence of complications(p=0.125). The postoperative complications occurred in 8 cases,7 cases of air leak more than 7 days and 1 case of respiratory insufficiency. In the diagnosis and treatment of the patients with findings of infiltrative lung on chest X-ray, the operative lung biopsy is the very necessary course, and shows satisfactory rate of diagnosis with negligible complications.

• Tuberculosis and Respiratory Diseases
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• v.74 no.1
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• pp.32-36
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• 2013

A 43-year-old woman with breast cancer who was on neoadjuvant chemotherapy presented with cough, sputum and mild fever. High-resolution computed tomography showed diffuse ground glass opacities in bilateral lungs and subpleural patchy consolidations. Initially, she was thought to have pneumonia or interstitial lung diseases such as drug-induced pneumonitis and treated with antibiotics and steroids. She subsequently got breast cancer surgery because of disease progression, and concurrent thoracoscopic lung biopsy revealed metastatic carcinoma of the lung from breast cancer. The diagnosis of suspected interstitial lung disease can be made without lung biopsy, but malignancy should always be considered and lung biopsy should be performed in the absence of a definitive clinical diagnosis.