Biopsie pulmonaire chirurgicale au cours des pneumopathies interstitielles diffuses

In almost a third of interstitial lung disease cases the contribution to histology through a surgical lung biopsy (SLB) is necessary for the care. SLB has an excellent diagnostic performance but is an invasive examination which must be performed only if a prognostic and therapeutic impact is expected. The major indication of SLB is the field of idiopathic pulmonary pneumonias, especially differential diagnosis between idiopathic pulmonary fibrosis, idiopathic nonspecific interstitial pneumonia and chronic hypersensitivity pneumonia, when environmental, clinical, biological and imaging data are not sufficient to make a diagnosis. There is no consensus on the contraindications of this technique, however there is a higher mortality among subjects above 70 years old, having at least an associated comorbidity, with a FVC < 55% or a DLCO < 35%. Video-assisted thoracoscopy is to favor against mini thoracotomy because of a lower mortality, but is not always achievable in case of emergency. SLB procedure must be strict, particularly several samples must be performed in 2 differents lobes.