Application of video-assisted thoracoscopic lung resections for differential diagnosis of lung diseases

The objective of the study: to determine the place and effectiveness of video-assisted thoracoscopic lung resection (VATS resections) in the differential diagnostic procedure for examination of patients with chest diseases.

Subjects and methods. In 2017-2019, 1,190 patients with suspected respiratory tuberculosis were examined in the differential diagnostic department of TB Dispensary, the Ministry of Health of the Kabardino-Balkarian Republic; 106 (8.9%) needed VATS since it was impossible to verify their diagnosis despite various biopsies. The age of 106 patients varied from 18 to 80 years old, there were 66 men (62.0%), and 40 women (38.0%). The preoperative diagnosis was as follows: single or multiple lung lesions – 83 (76.9%) cases, disseminated lung disease of unknown etiology or interstitial lung disease of unspecified etiology – 25 (23.1%) cases.

In all cases, the surgical specimens were sent for comprehensive tests, including histological tests, microbiological tests (fluorescent microscopy with Ziehl-Nielsen staining, culture for Mycobacterium tuberculosis (MTB) by Bactec, and culture for secondary flora and fungi), and molecular genetic tests to detect MTB DNA.

Results. The diagnostic efficiency when using VATS resections, histological and microbiological testing of surgical specimens made 98.1% (95% CI 93.38-99.48; Wilson's method). Among the diagnosed diseases, pulmonary tuberculosis was confirmed in 47/106 (44.3%) patients, cancer – 37/106 (34.9%), the rest of patients were diagnosed with some other disorders including orphan diseases.

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