Thoracoscopy for diagnosis of diffuse lung disease.
Diffuse lung diseases due to a wide variety of conditions are amenable to diagnosis by means of clinical evaluation, bronchoalveolar lavage, transbronchial biopsy, and lung biopsy. The recently introduced technique of thoracoscopic wedge biopsy provides the potential advantages of greater selection of biopsy sites and reduced postoperative pain compared with that associated with standard open lung biopsy. Its overall accuracy cited in initial reports has exceeded 90%. Although it is supplanting open lung biopsy as the most common operative technique for diagnosing diffuse pulmonary abnormalities, the availability of thoracoscopic lung biopsy should not alter the current indications for the initial use of bronchoscopic techniques in selected patients. In addition, because of the additional risk carried by thoracoscopic lung biopsy, open lung biopsy should still be used preferentially in patients suffering from acute decompensation, pulmonary hypertension, or coagulation disorders.