VATS Biopsy Considerations

I was recently going through my patient journey journals. I try to keep pretty meticulous notes, ranging from medical information to symptom tracking, goals, and reviews of experiences and all the feelings I had. I often refer back to them, especially when I go through a decline in asthma control and when I have had treatment failures. In a recent review, I found that at one time I was considering a VATS biopsy to see if I had evidence of granulomas, which may be connected to asthmatic granulomatosis.¹

Asthmatic granulomatosis is defined as the presence of severe asthma that has features of histologic changes in the small airways including alveolar septal mononuclear infiltrates and interstitial non-necrotizing granulomas.² It is a mouthful of things to digest and, from what I understand, the key has been determining the presence of the non-necrotizing granulomas.

How do you find these granulomas?

When I was exploring this connection, the determination of the granulomas was conducted through a VATS biopsy. VATS stands for Video-Assisted Thoracoscopic biopsy. This procedure is commonly used to investigate and evaluate interstitial lung disease.¹

VATS has had limited scope in asthma, although researchers are gaining more information into the connection to autoimmune disease presence in asthma. While further research is needed to fully make these connections, a number of researchers are making progress in these connections.³

What is a VATS biopsy?

A VATS biopsy is a minimally invasive procedure that allows your surgeons to get a better look at your lungs and take a sample (biopsy) for further evaluation. It uses small incisions to insert a surgical camera (endoscope) to view and obtain the samples.²

In preparation, you will likely have a breathing tube inserted that will provide oxygen to use.² In my circumstance, the procedure was going to deflate one lung to obtain the sample and I would have had a chest tube in for a few days afterward.

Why are VATS biopsies conducted?

A VATS biopsy, in my case, was suspected to yield findings of inflammation and the presence of granulomas in the small airways.³ I had already had a number of diagnostics, such as CT scans, bronchoscopies, and lung function testing before VATS was even considered. This also followed seeing a number of specialists and is generally not something that is entered into lightly.

My concerns

I was weighing the options of having a VATS biopsy. It was not an easy decision for me. There were a couple of things I was concerned about:

• Not all my specialists were in agreement that I should have it done.
• A VATS has some risks involved, like most procedures. There were concerns about the potential for a post-procedure decline in lung function and complications with the reinflation of the lung.
• In my case, there would have been some hospitalization recovery also involved. It is important to remember that not everyone may have the same requirements and that you should speak to your care team about any concerns you may have.

VATS biopsy for asthma

It was decided that there was not enough evidence for me to have it at that time, as the potential that they would find valuable information was not as high as I would have liked it to have been. Research and perspectives have since changed and I would be curious to have this procedure done now to see if there would be valuable findings.