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Histopathological Reporting of Pulmonary Biopsies in Cases of Idiopathic Pulmonary Fibrosis

Dr Sampurna Roy MD 




- Trans-bronchial lung biopsy (TBLB) is the initial procedure of choice in those patients likely to have diffuse parenchymal lung disease  in which small samples may be diagnostic.

- These biopsies are not useful for the diagnosis or staging of the various histopathological subsets of Idiopathic Pulmonary Fibrosis.

- By open/video assisted thoracoscopic (VATS) lung biopsies it is possible to adequately examine the secondary lobules and the distribution of the disease process.

- These biopsies should be at least 4 cm in maximum diameter when inflated and include a depth of at least 1.5 cm.

- Biopsy samples from the middle lobe or lingula may be taken provided they are of adequate size, contain deep alveolar tissue and are from a site involved by active disease.


Histological interpretation of lung biopsies and what to look for - a brief practical guide:

1.  Detailed clinical history and radiological findings should always be obtained and taken into consideration in the interpretation of lung biopsies.

2.  Low power magnification:

   - The distribution, intensity, and nature of fibrosis and inflammation.

   - Is the disease process temporally uniform.  Example: Non-specific interstitial pneumonia (NSIP) or temporally and spatially heterogeneous  Example: Usual Interstitial Pneumonia (UIP)?

   -  Are the changes predominantly centri-lobular,  Example: Respiratory bronchiolitis-interstitial lung disease (RBILD) , diffuse throughout the secondary lobule (Example: NSIP ), or predominantly sub-pleural (Example: UIP )?

3.  Bronchi or bronchioles (any abnormality such as bronchiolitis obliterans?).

4.  Alveolar lumina (any abnormality, such as organizing exudates, accumulation of macrophages, giant cells, hemorrhage, hyaline membrane?)

5. Epithelial lining (any hyperplastic, metaplastic or neoplastic changes? Any viral inclusions?)

6. Blood vessels (any evidence of  veno-occlusive disease which may produce parenchymal changes similar to IPF? Any vasculitis? Or thrombi?), lymphatics (any abnormality?).

7. Interlobular septa (any abnormality?).

8. Pleura  (is there any fibrosis/chronic inflammation, example: in collagen vascular disease and asbestosis?).

9.  Any ferruginous bodies (particularly asbestos)/ Any pigment (Example: hemosiderin)?  Asbestosis

10. Are there any granulomata, or scattered individual giant cells? Any foreign material?

11. Is there any smooth muscle proliferation? Are the smooth muscle fibers mature?

12. Any other abnormality (Example: amyloid).


Further reading:

Transbronchial biopsy interpretation in the patient with diffuse parenchymal lung disease.

Mortality and risk factors for surgical lung biopsy in patients with idiopathic interstitial pneumonia.

[Low-dose CT-guided transthoracic lung biopsy for evaluation of non-infectious chronic interstitial lung disease in children].

Complications of video-assisted thoracoscopic lung biopsy in patients with interstitial lung disease.

Diffuse interstitial lung disorders in systemic diseases .



Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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