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Clinical Investigations: CT, TBX, AND Pulse OXTransbronchial Lung Biopsy: Can Specimen Quality Be Predicted at the Time of Biopsy?
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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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