Thoracoscopic lung biopsy. Experimental and clinical preliminary study.

We have investigated thoracoscopic lung biopsy (TLB) as an alternative to surgical biopsy. TLB was performed under mild general anesthesia, with two openings: one for the telescope, and one for a 5 mm in diameter biopsy forceps connected to diathermocoagulating device. TLB was first tested on 14 dogs (22 TLB) and then on 75 subjects (77 TLB): 35 patients with pleural diseases and 40 patients with undiagnosed lung diseases despite previous investigations including transbronchial biopsy. TLB yielded a high rate of adequate samples (up to 5 x 5 x 5 mm) in both experimental (95 percent) and clinical series (96 percent). Overall sensitivity equalled 923 percent, ranging from 70 percent in peripheral localized lesions to 100 percent in diffuse lung diseases. The mean period of systematic drainage was 3.4 +/- 0.3 days, and the main complications we encountered were one transient blood-streaked sputum specimen and eight localized pneumothoraces during drainage. TLB is indicated when other medical procedures have failed, and has thus proved, in this series, to be as sensitive as surgical biopsy with less morbidity and no mortality.