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Pulmonary Pathology Online

Transbronchial Biopsy Specimen

 Dr Sampurna Roy MD

 

                                                                                                                      

 

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.

 

Indication:

 

- In the investigation of diffuse lung disease;

 

- In the diagnosis of peribronchial neoplastic infiltrates;

 

- In immunosuppressed patients to assess infection and following transplantation to identify infection and graft rejection.

 

 

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.

                                                                                         

Endoscopic biopsies can be sectioned in one of the two ways:

- For anticipated neoplastic infiltrates, as 4-5 micron sections, stained with hematoxylin and eosin at 40 micron intervals with multiple unstained sections placed directly on agar/ saline coated slides suitable for immunohistochemistry.

- For post-transplantation transbronchial biopsies, multiple levels throughout the tissue (complete sampling) is preferred to identify small isolated lesions.

 

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.

 

Further reading:

[Usefulness of transbronchial and surgical biopsies for the management of interstitial lung disease].

Histopathologic findings of transbronchial biopsy in usual interstitial pneumonia.

Role for transbronchial biopsy in the diagnosis of usual interstitial pneumonia.

Transbronchial biopsy in usual interstitial pneumonia.

Surveillance transbronchial biopsy in the diagnosis of acute lung rejection in heart and lung and lung transplant recipients.

Interpretation of tissue artifacts in transbronchial lung biopsy specimens.

Effectiveness of transbronchial needle aspiration in the diagnosis of exophytic endobronchial lesions and submucosal/peribronchial diseases of the lung.

[Transbronchial needle aspiration].

The role of transbronchial biopsy for the diagnosis of diffuse pneumonias in immunocompromised marrow transplant recipients.

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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