To evaluate the efficacy and safety of surgical lung biopsy in the diagnosis of diffuse parenchymal lung disease (DPLD).

We retrospectively analyzed the clinical data of 54 consecutively-suspected DPLD cases who received surgical lung biopsy in the Department of Respiratory and Critical Care Medicine of Nanjing Drum Tower Hospital during January 2006 to September 2018.

Among the 54 cases, the lung biopsy was performed by video-assisted thoracoscopic surgery in 37 cases and by open lung biopsy in 17 cases. The most common postoperative pathological diagnosis was organized pneumonia, and a definite diagnosis was obtained in 48 patients after the procedure. The therapeutic schedule was changed in 38 cases according to the diagnosis after surgery. The patients who accepted minimally invasive lung biopsy without definite diagnosis were mostly (96%) confirmed after surgical lung biopsy. Surgical complication occurred in 15 cases out of the 54 cases, with the morbidity of 27.8%, including pneumothorax in 9 cases, pulmonary infection in 5, delayed weaning ventilator (>48 h after surgery) in 3, respiratory failure in 3, re-intubation in 1, postoperative bleeding in 1, and tracheotomy in 1. The 30-day postoperative mortality was 1.9%, mostly due to respiratory failures. There was no statistical significant difference in sex, age, the preoperative percentage of the forced vital capacity (FVC%pre), the preoperative percentage of the forced expiratory volume in one second (FEV₁%pre), the preoperative percentage of the diffusing capacity of the lungs for carbon monoxide (DLCO%pre), the preoperative partial pressure of oxygen in artery (PaO₂), the preoperative steroids use and the operation methods (P>0.05) between the complication group and the non-complication group.

For the patients with undiagnosed DPLD after combination with clinical history, high-resolution CT (HRCT) of the chest, laboratory examination and data of minimally invasive lung biopsy, surgical lung biopsy can be used as the last meaningful examination method, with a diagnosis rate of 88.9%. Surgical lung biopsy is a relatively safe and reliable method for the diagnosis of DPLD, but the patients with poor basic conditions are more likely to suffer from postoperative complications. Such patients should avoid surgical lung biopsy as far as possible.