Pulmonary Pathology Online
Histopathological Reporting of Bronchial Biopsy Specimens
- The main indication for bronchial biopsy is diagnosis of bronchogenic neoplasia. For bronchoscopically visible tumours diagnosis is possible in up to 90% of cases.
- A wide range of other endobronchial and bronchial wall lesions (including inflammatory lesions) can be sampled.
- The rigid bronchoscope can be used as a diagnostic and therapeutic tool.
These are used in the extraction of inspissated mucoid plugs, blood clot and aspirated foreign material.
It may also be used for endobronchial resection of carcinoid tumors.
- The rigid bronchoscope is also the instrument of choice for biopsying vascular neoplasms.
The biopsy site is limited to lobar and some segmental bronchi.
- Flexible fibreoptic bronchoscopy requires topical airway anesthesia and is useful for investigation and biopsy of the subsegmental bronchi.
A small amount of lung parenchyma may be included in a bronchial biopsy.
Assessment of interstitial changes on small parabronchial fragments should be made with caution - the results may not be representative of the parenchyma away from this area and may be misleading.
to histopathological reporting of a bronchial biopsy:
- The report should contain information on the adequacy of the biopsy and the tissues and other material present.
- When disease is identified, the report should indicate whether the primary disease is neoplastic or inflammatory.
(I) For biopsies showing dysplasia the report should comment on the:
- severity of the dysplasia: mild, moderate, severe, carcinoma in situ:
- presence of associated inflammatory changes:
(II) For invasive malignant tumour, the report should comment on the:
- Primary lung carcinoma: small cell carcinoma ; non-small cell carcinoma (squamous or glandular differentiation); mixed types; other distinctive types of carcinoma - giant cell carcinoma;
- Non-epithelial malignancy: Lymphoma ; Sarcoma.
- Metastatic tumour;
Degree of differentiation (if assessable):
Tissues involved by the tumor. Example: Cartilage:
Presence of vascular invasion.
Presence of associated metaplasia or dysplasia in surface epithelium.
III) Presence of associated inflammatory changes:
For biopsies showing bronchial inflammation the report should comment on the:
Mucosa: Ulceration ; presence and type of intraepithelial inflammatory cells ; relative number of goblet cells; presence of squamous metaplasia ; thickening of the basement membrane (Example: Asthma) ; viral inclusions in surface epithelial cells.
Submucosa: Acute inflammation ; non-specific chronic inflammation ; Eosinophilic inflammation (Example: Asthma, Churg-Strauss disease, parasitic infestation such as helminthiasis) ; Granulomatous inflammation :
(Example: Sarcoidosis, tuberculosis, allergic bronchopulmonary aspergillosis, bronchocentric granulomatosis) ; Vasculitis (Example: Wegener’s granulomatosis, polyarteritis nodosa - PAN , Churg-Strauss disease).
Luminal contents: Presence of mucus and inflammatory cells, particularly neutrophils , eosinophils ; fungal elements such as Aspergillus and foreign material.
Cartilage: Osseous metaplasia as in bronchopathia osteoplastica ; inflammation as in relapsing polychondritis.
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