Needlescopic Lung Biopsy for Interstitial Lung Disease and Indeterminate Pulmonary Nodules: A Report on 65 Cases

Background: We evaluated the feasibility and accuracy of a needlescopic procedure for lung biopsies in patients with interstitial lung disease or indeterminate pulmonary nodules. Methods: Sixty-five patients (36 women; mean age, 51.3 ± 15.6; range, 13 to 76 years) underwent a needlescopic procedure to obtain lung biopsy specimens. Forty had indeterminate pulmonary nodules, and 25 had interstitial lung disease. A 2-mm needlescope and a 2-mm MiniSite Endo Grasp (Covidien, Norwalk, CT) were inserted at the sixth intercostal space along the middle and the posterior axillary line, respectively. Biopsy specimens were obtained using endostaplers. Results: The average number of biopsy specimens was 1.7 ± 0.6 (range, 1 to 4). For 9 patients, a frozen specimen was sent twice to pathology. Complete resection was continued after intraoperative pathology confirmation in 13 patients (lobectomy, 7; segmentectomy, 3; mass removal, 1; metastasectomy, 2). The volume of lung tissue was 8.7 ± 11.8 cm³ (range, 0.15 to 55.44 cm³). The operation time was 58.7 ± 37.5 minutes (range, 15 to 160 minutes). The final pathologic results were confirmed in all patients. No thoracoscopic procedure was converted to an open thoracotomy. Three patients (4.3%) had prolonged air leakage (> 5 days), and the chest tube remained in the pleural space for 2.3 ± 2.4 days (range, 1 to 8 days). Conclusions: Needlescopic operation for lung biopsies in patients with interstitial lung disease and indeterminate pulmonary nodules is a minimally invasive procedure that is safe and effective for obtaining a diagnosis in selected patients.