Ann Thorac Surg 2000;69:1018-1019
© 2000 The Society of Thoracic Surgeons
ORIGINAL ARTICLES: GENERAL THORACIC
Invited commentary
Carolyn E. Reed, MDa
a Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC 29425-2279, USA
e-mail: reedce{at}musc.edu
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 Introduction
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This article confirms the findings of others, that biopsy of the lingula is acceptable for diagnosis of diffuse lung disease. In addition, Temes and associates confirm that a single biopsy specimen is sufficient. For elective biopsies and for nonventilated patients, video-assisted thoracoscopy (VATS) is favored. In this regard, the commentator prefers a right-sided approach, since there are more fissures or edges for stapling. A single lung biopsy will decrease the chances of air leak, which is the most frequent complication that extends length of stay. For elective VATS cases, the chest tube can be removed in the recovery room or several hours later, and the patient can be discharged within 24 hours of the procedure. Perhaps, the one exception to disregarding specific location of biopsy is in the honeycomb lung. A less involved area by computed tomographic scan is preferred to avoid the finding of burned out fibrosis on histologic examination. This lung is also more susceptible to air leak after biopsy.
An additional important observation by Temes and associates is the lack of necessity of sending specimens for multiple cultures in the immunocompetent patient. This practice only increases cost. An important exception is when the computed tomographic scan shows characteristics consistent with atypical tuberculosis.
The potential risks and cost associated with surgical lung biopsy needs to be balanced against the accuracy of clinical diagnosis, the likelihood of identifying a treatable form of interstitial lung disease, and the efficacy of treatment. Temes and associates have confirmed that the lingula is a safe and accurate site for the diagnosis of diffuse lung disease.
Related Article
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The lingula is an appropriate site for lung biopsy
- R. Thomas Temes, Nancy E. Joste, Nechol L. Allen, Richard E. Crowell, Hector A. Dox, and Jorge A. Wernly
Ann. Thorac. Surg. 2000 69: 1016-1018.
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