A surgical biopsy is both the most reliable way of diagnosing pulmonary fibrosis (PF) and the most invasive way. A tissue sample needs to be removed from the patient’s lung in order to be analyzed and determine if there is thickening  of the pulmonary walls. Still, it’s reliability means it’s often necessary.

A surgeon may choose one of two techniques to obtain the tissue sample required for analysis: a thoracotomy or a video-assisted thoracoscopic surgery (VATS). The decision about which surgery to perform depends on the physician’s evaluation of each patient.

What is a thoracotomy?

thoracotomy is open surgery and the most invasive of the two surgical biopsy procedures. The surgeon makes an incision in the chest and exposes the lung to retrieve a tissue sample.

General anesthesia is required and the healing process can be long and painful. A greater risk of infection exists because the thorax is exposed during surgery, and the post-surgical process is difficult.

What is a video-assisted thorascopic surgery?

Video-assisted thoracoscopic surgery, or VATS, is a less invasive procedure. To perform this operation, the surgeon makes two or three small incisions between the ribs of the patient. A small camera is inserted through one of the incisions, allowing the physician to view the anatomy of the thorax and the position of the surgical instruments that are inserted through the other incisions to acquire a tissue sample.

Even though VATS is less invasive than a thoracotomy, it still requires a general anesthesia. However, the recovery process is usually less painful and much faster. The smaller wounds also heal quicker, decreasing the risk of infection.

Tissue analysis

The lung tissue sample acquired during surgery is then carefully analyzed by a pathologist. The sample needs to be processed in order to allow the pathologist to clearly see the structure of the cells under the microscope.

The pathology laboratory prepares a report of the sample analysis and sends it to the patient’s physician to decide on the best course of treatment.

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