Does lung biopsy worsen lung function, survival in IPF patients?

Surgical lung biopsy (SLB) neither reduces lung function nor increases the risk of death or lung transplantation in patients with idiopathic pulmonary fibrosis (IPF), reports a study.

“[W]e did not find that SLB was associated with accelerated lung function decline in patients with IPF, which may reflect appropriate patient selection for SLB and provide reassurance in scenarios where it is thought to be indicated,” said lead author Dr Veronica Marcoux from the Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

“We also did not find an increased risk of death in this cohort recognizing the limitations of this analysis,” she added.

Marcoux and her team compared the decline in forced vital capacity (FVC)%, diffusion capacity of the lung (DLCO%), and risk of death or lung transplantation between SLB and non-SLB patients using linear mixed models and Cox proportional hazards regression models, adjusted for age, sex, smoking history, antifibrotic use, and lung function.

In addition, the research team performed a similar analysis to compare lung function changes 12 months prior to and after SLB.

Of the participants, 81 underwent SLB and 468 did not. The postbiopsy annual FVC% decline in SLB patients was 2.0 percent in the unadjusted model and 2.1 percent in the adjusted model. [Respirology 2024;29:596-604]

No between-group differences were observed in FVC% decline, DLCO% decline, or time to death or lung transplantation in both unadjusted and adjusted models (p>0.07 for all). There were also no differences seen in FVC% decline in the pre-post SLB group in unadjusted or adjusted models (p=0.07 for both).

“In this multicentre registry-based study, we found that SLB was not associated with accelerated lung function decline in patients with IPF compared to lung function decline in those not undergoing SLB,” Marcoux said. “Lung function decline appeared attenuated in the pre-post-SLB comparison; however, findings are limited by the small sample size.”

Surgical technique

Additionally, SLS showed no association with a higher risk of death or lung transplantation, with no deaths seen within 1 months as opposed to two deaths (1.7 percent) in an earlier study. [Respiration 2020;99:1101-1108]

“These findings contradict our original hypothesis and the most recent ILD specialized single-centre retrospective study that demonstrated significant lung function decline after biopsy,” Marcoux said.

“It was presumed that SLB may result in accelerated lung function decline due to the removal of potentially functional lung or from acute exacerbations due to the process of mechanical ventilation and surgical manipulation of lung tissue,” she added.

“Evolving surgical technique and ventilation measures in addition to proper selection of patients for SLB may contribute to our overall findings,” Marcoux said.

In a previous UK study, SLB was found to be associated with in-hospital (1.7 percent), 30-day (2.4 percent), and 90-day mortality (3.9 percent). A Canada study also found an estimated 7.1-percent 30-day overall mortality with SLB for ILD, with a higher risk for nonelective vs elective procedures (20.2 percent vs 1.9 percent). [Eur Respir J 2019;53:1801164]