Chest
Volume 113, Issue 4, April 1998, Pages 1037-1041
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Clinical Investigations: CT, TBX, AND Pulse OX
Transbronchial Lung Biopsy: Can Specimen Quality Be Predicted at the Time of Biopsy?

https://doi.org/10.1378/chest.113.4.1037Get rights and content

Study objectives

To determine the bronchoscopist's ability to predict specimen quality at the time of transbronchial biopsy and to determine the influence of biopsy specimen size and alveolar content on diagnostic value.

Design

Prospective, blinded, observational analysis.

Setting

Tertiary care academic hospital-based pulmonary practice.

Patients

Forty-three adult patients who underwent transbronchial lung biopsy.

Interventions

Each of 170 biopsy specimens was rated as to likelihood of containing diagnostic tissue, size and ability to float, tissue types present, number of alveoli, and pathologic diagnosis.

Results

Fifteen percent of biopsy specimens were small and 40% were large. Seventy-six percent of specimens floated; 61.8% of the 170 biopsy specimens contained abnormal lung tissue; and 14.7% of individual specimens were diagnostic. Fifty-two percent of specimens contained >20 alveoli. Larger biopsy specimens were more likely to contain diagnostic tissue (r=0.29, p=0.001). Cup forceps retrieved smaller pieces of tissue (p=0.007) and were less likely to obtain diagnostic tissue (p=0.06). Physician ratings of specimen quality (mean±SD) did not differ between specimens containing normal and abnormal tissue (5.98±2.3 vs 5.46±5.5; p=0.24) or between specimens containing diagnostic vs nondiagnostic tissue (5.56±2.5 vs 6.25±2.1; p=0.14). Specimens that floated were no more likely to be diagnostic or abnormal than specimens that sank (p<0.05). Diagnosis when established was made by the first biopsy specimen in 53.3% and the second in 33.3%

Conclusions

Physician estimate of biopsy specimen quality and the float sign are not helpful in predicting that the biopsy specimen contains abnormal or diagnostic tissue. Diagnostic biopsy specimen will likely be obtained if the size of the specimen fills the forceps, 2 to 4 biopsies are performed, and toothed forceps are used.

Section snippets

MATERIALS AND METHODS

The study design was a prospective, blinded, observational analysis and was approved by the Committee on the Protection of Human Subjects in Research at the University of Massachusetts Medical Center. The study compared a bronchoscopist's ability to assess specimen adequacy and quality at the time of transbronchial lung biopsy with final pathologic characteristics determined on slide microscopic examination of the tissue slides.

All patients undergoing transbronchial lung biopsy at the

RESULTS

During the study period, 43 patients (22 male and 21 female) underwent transbronchial lung biopsy. The patients' ages ranged from 28 to 83 years, with a mean age of 59.6 years. Seven physicians performed transbronchial biopsies. The physicians had an average of 8 years of bronchoscopic experience, ranging from 3 to 19 years. All but one patient had undergone CT scanning of the chest prior to biopsy. There were no pneumothoraces or hemorrhages >10 mL as result of biopsy. The technician involved

DISCUSSION

Bronchoscopy may provide a diagnosis by visualization of a lesion, cultures of tissue or suctioned secretions, cytologic analyses of secretions or needle aspirates, more sophisticated analyses of BAL fluid, or pathologic characterization of lung tissue from biopsy specimens. This study was designed only to evaluate the results of transbronchial lung biopsy. Yield from bronchoscopy is clearly increased when other specimens in addition to biopsy specimens are obtained. As our protocol evaluated

CONCLUSION

This study suggests that physician estimate of biopsy specimen quality and the float sign are not helpful in predicting that the biopsy specimen contains abnormal or diagnostic tissue and should not be used to determine the number of biopsy specimens obtained or predict specimen quality. Until better predictors of diagnostic yield at the time of transbronchial biopsy can be established, we would recommend the following: (1) no biopsy specimen should be considered acceptable unless the size of

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