Cryo-transbronchial lung biopsy in the diagnosis of IgG4-related lung disease

Transbronchial lung biopsy through the flexible bronchoscope is used widely for the diagnosis of diffuse lung disease; however, a significant number of specimens obtained by the bronchoscopic 2-mm biopsy forceps will reveal nonspecific findings, eg, interstitial fibrosis or nonspecific pneumonitis. Such a report may be an accurate reflection of the presence of idiopathic pulmonary fibrosis or nonspecific pneumonitis, but may merely indicate that the true diagnosis has been missed. We retrospectively studied 38 patients with diffuse lung disease whose transbronchial lung biopsies yielded nonspecific abnormalities. Subsequently, these patients were subjected to open lung biopsies. Nineteen of the 38 patients (50%) had a specific diagnosis made by open lung biopsy. The diagnoses included bronchiolitis obliterans, alveolar proteinosis, metastatic carcinoma, lymphoma, tuberculosis, and bronchioloalveolar cell carcinoma. Although transbronchial lung biopsy is useful in the diagnosis of many diffuse lung diseases, it is not a replacement for open lung biopsy. When nonspecific findings by transbronchial lung biopsy do not correlate with the clinical picture, open lung biopsy should be performed.

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The value of transbronchial lung biopsy using jumbo forceps via rigid bronchoscope in diffuse lung disease

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2008.397 ◽

2016 ◽

Vol 69 (2) ◽

Cited By ~ 1

Author(s):

G.L. Casoni ◽

C. Gurioli ◽

P.N. Chhajed ◽

M. Chilosi ◽

M. Zompatori ◽

...

Keyword(s):

Lung Disease ◽

Lung Biopsy ◽

Diagnostic Yield ◽

Random Sequence ◽

Lung Nodule ◽

Rigid Bronchoscopy ◽

Transbronchial Lung Biopsy ◽

Rigid Bronchoscope ◽

Diffuse Parenchymal Lung Disease ◽

Diffuse Lung

Background. Transbronchial lung biopsy (TBLB) is a valuable procedure used to obtain a parenchymal specimen in the evaluation of diffuse lung infiltrates. Large forceps are expected to result in larger specimens and improve diagnostic yield. Aim. The objective of this study was to evaluate diagnostic yield of TBLB using large modified flexible gastroenterological forceps (“Jumbo forceps”) compared with ‘normal’ flexible forceps via rigid bronchoscopy in patients with diffuse parenchymal lung disease (DPLD). Methods. The study was a prospective analysis of 95 patients who underwent fluoroscopy guided TBLB over a two year period. Patients with a lung mass or solitary lung nodule undergoing TBLB were excluded. The larger and small forceps were used in a random sequence to avoid a reduction in diagnostic yield of the second series of biopsies related to possible bleeding by first series of biopsies. To minimize the consequence of haemorrhage, we performed every rigid bronchoscopy, placing a non inflated Fogarty balloon and a rigid aspirator (diameter 4 mm) in lobar bronchus near the biopsy segment. The Fogarty balloon has been inflated in case of bleeding. After the bleeding was controlled we continued to operate up to the biopsy segment. Results. Diagnostic yield of TBLB using Jumbo forceps was significantly higher than using normal flexible forceps via rigid bronchoscopy in patients with DPLD (p=0.001). In 74 out of 95 patients (78%) the diagnosis was placed with Jumbo forcep while the smaller forcep was diagnostic in 62 out of 95 patients (65%). Large forceps obtained significantly more tissue than the small forceps; the biopsy specimen taken with normal forcep measured in average 1.4 x 1.0 mm and the larger biopsy taken with jumbo forcep measured in average 2.5 x 1.9 mm (p < 0.005). Conclusion. The use of large biopsy forceps to perform TBLB via rigid bronchoscope can significantly increase diagnostic yield in the pathological diagnosis of diffuse infiltrative lung disease.

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