Pulmonary Pathology Online
Transbronchial Biopsy Specimen
Transbronchial needle aspiration was initially invented in 1949 by Schieppati.
After its adaptation to the flexible bronchoscope in 1983 by Wang this technique has gain firm indications in the diagnosis and staging of lung cancer, in peripheral pulmonary nodules and masses; in the evaluation of endobronchial masses, in the disease of submucosal, in benign diseases, i.e. sarcoidoses and mediastinal cysts and abscesses.
Relating to the small specimen size, the diagnostic accuracy is better for those conditions exhibiting specific pathological features such as sarcoidosis and lymphangitis carcinomatosa.
Approximately 90% of opportunistic infections can be diagnosed by transbronchial biopsy in conjunction with lavage.
Following transplantation it is routinely used to monitor rejection manifesting as lymphocytic bronchitis / bronchiolitis (acute rejection) and obliterative bronchiolitis (chronic rejection).
Bronchoalveolar lavage is routinely combined and submitted for pneumocystis carinii, viral, fungal, and bacterial (including mucobacterial) stains.
Complications: Bronchospasm, vasovagal attack, hypoxia, hemorrhage and pneumothorax.
Transbronchial biopsy is associated with a slightly higher complication rate than endobronchial biopsy.
Rigid bronchoscopy is complicated by risks related to general anaesthesia. Serious complications are rare.
Advantage of transbronchial biopsy over open lung biopsy : Low cost and low complication rate.
Disadvantage of transbronchial biopsy : Due to small specimen size it is inadequate in assessing disease distribution and extent.
Specimen handling of Endoscopic Biopsies:
Bronchial and transbronchial biopsies rarely exceed 3 mm diameter and diagnostic yield increases with multiple biopsies.
In general the endoscopist should directly place all specimens for histological examination into buffered formalin.
If bacterial, mycobacterial, virus or fungal cultures are considered important, specimens should be sent directly to the corresponding laboratory by the clinician.
The size and number of fragments sampled are important to document.
This ensures that all have been individually examined histologically.
For bronchial biopsy, where the procedural indications are wide, a number of anatomical compartments should be assessed: respiratory epithelium, lamina propria, submucosa, seromucous glands and cartilage.
For transbronchial specimens, all of the above should be assessed and above all alveolated lung parenchyma should be present.
A variety of additional stains are useful in establishing the diagnosis and indications will vary according to the light microscopic findings.
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