The Annals of Thoracic Surgery, Vol 30, 411-426, Copyright © 1980 by The Society of Thoracic Surgeons
Open biopsy for chronic diffuse infiltrative lung disease: clinical, roentgenographic, and physiological correlations in 502 patients
EA Gaensler and CB Carrington
Clinical, physiological, roentgenographic, and histological data concerning
502 patients who had open biopsy for chronic "interstitial" lung disease
were reviewed. Mortality was 0.3%, the rate of complications was 2.5%, and
the diagnostic yield was 92.2%. A modified Chamberlain approach in the
second interspace is preferred for easy access to all lobes and
mediastinum. Brief tube drainage is mandatory. Atelectasis and hemorrhage
in the specimen are prevented by avoiding palpation and clamps, by
delineating the wedge during full inflation, and by instant fixation.
Customary biopsies of the tip of the lingula or middle lobe are avoided
because these are common sites of inflammation, scarring, and passive
congestion. Often, the most abnormal regions are biopsied apparently to aid
the pathologist. Such selection has been the most important cause of
meaningless histological findings and poor pathological, physiological, and
roentgenographic correlations because these regions usually show end-stage
disease of unrecognizable origin. Average lung is more likely to show an
active and recognizable process.
