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Correlation between the clinical and pathohistologic
diagnosis in "small biopsies" of the lung.Med
Pregl. 1998 Sep-Oct;51(9-10):431-5.
Med Pregl.
1998 Sep-Oct;51(9-10):431-5.
INTRODUCTION:
During the last 20 years routine application of various methods of
multiple "small biopsies" of the lungs such as forceps,
transbronchial, trucut percutaneous and so on, has significantly
increased the efficacy of diagnostics of bronchopulmonary and
pleural diseases. Tissue samples, not bigger than 3-4 mm, in which
diagnostic pathological changes are expected on the basis of
previous clinical, radiological and bronchoscopic examinations, can
be the basis for making a definite therapeutical decision only if a
skillful surgeon has performed the biopsy by correct instruments and
from the right place and sent it for histological analysis with
other important clinical information. This study is a comment on
quality, significance and possibilities of improving
clinical-pathological cooperation in this field of clinical
pathology. MATERIAL AND METHODS: By correlation of clinical and
histological diagnoses we analyzed the diagnostic efficiency of
microscopic examinations of "small biopsies" of the respiratory
tract in 319 patients (175 bronchial forceps biopsies, 31
transbronchial biopsies, 22 percutaneous needle pleural biopsies and
91 combined forceps and transbronchial biopsies) in whom biopsies
were performed during 1996 in the Specialized Hospital for Lung
Diseases Brezovik. RESULTS: Overall concordance between the clinical
and histopathological diagnosis was 82.2%. In 99 cases (73.3%) out
of 135 clinically "obvious" neoplasms, the histopathological
examination confirmed existence of malignant tumor: squamous cell
carcinoma in 80%, small cell carcinoma in 9.6% and adenocarcinoma in
5.6% of patients. In other patients it was not possible to perform a
more precise classification. Endoscopic specimens of 29 patients
(9.1%) were not representative. CONCLUSION: The level of diagnostic
efficiency (73.3%) of definitive histopathological verification of
bronchopulmonary lesions, which have been clinically diagnosed as
malignancies, is rather high, but the increase of diagnostic
efficiency requires application of more sophisticated histological
diagnostic methods (immunohistochemical) and more frequent
utilization of bioptic procedures which are more convenient for
detection of peripheral pulmonary lesions (transbronchial and
percutaneous fine needle aspiration biopsies of the lungs).
Bronchoscopic diagnosis and staging of lung cancer.Chest
Surg Clin N Am. 2001 Nov;11(4):701-21,
vii-viii
In the past
2 decades, flexible bronchoscopy (FB) with forceps biopsy and
transbronchial needle aspiration (TBNA); computed tomography
(CT)-guided, transthoracic fine-needle aspiration (FNA); and
endoscopic ultrasonography (EUS) have revolutionized lung cancer
diagnosis and staging by facilitating precise biopsy of lung lesions
and virtually all mediastinal lymph-node stations. In this article
the authors present an algorithm for the diagnosis and staging of
lung cancer that addresses sampling of suspicious lesions and lymph
nodes by means of FB, CT, ultrasonography, fluoroscopy, and EUS,
emphasizing tissue-based diagnosis and staging by means of
image-guided technology with the highest diagnostic yield. They
discuss the approach to the diagnosis and staging of lung cancer by
techniques guided by FB, with particular attention to the increasing
role of TBNA in this field. Additionally, the authors propose a
rating scale based on the degree of invasiveness and diagnostic
yield, comparing FB with other diagnostic techniques.
Bronchoscopic needle aspiration biopsy.Am
J Clin Pathol. 2000 May;113(5 Suppl
1):S97-108
Bronchoscopic
needle aspiration biopsy, which encompasses transbronchial needle
aspiration, transtracheal needle aspiration, and endobronchial
needle aspiration, is a minimally invasive technique used to
diagnose mediastinal and pulmonary masses and to stage lung cancer
patients with mediastinal lymphadenopathy. Since it is safe,
accurate, and potentially cost-efficient, its use may increase in
the coming years. It is important that pathologists who examine
cytology specimens understand this procedure, its limitations, and
ways that it may be optimized.
Bronchoscopy
in diffuse lung disease: evaluation by open lung biopsy in
nondiagnostic transbronchial lung biopsy.Ann
Otol Rhinol Laryngol. 1987 Nov-Dec;96(6):654-7
Transbronchial lung biopsy
through the flexible bronchoscope is used widely for the diagnosis
of diffuse lung disease; however, a significant number of specimens
obtained by the bronchoscopic 2-mm biopsy forceps will reveal
nonspecific findings, eg, interstitial fibrosis or nonspecific
pneumonitis. Such a report may be an accurate reflection of the
presence of idiopathic pulmonary fibrosis or nonspecific pneumonitis,
but may merely indicate that the true diagnosis has been missed. We
retrospectively studied 38 patients with diffuse lung disease whose
transbronchial lung biopsies yielded nonspecific abnormalities.
Subsequently, these patients were subjected to open lung biopsies.
Nineteen of the 38 patients (50%) had a specific diagnosis made by
open lung biopsy. The diagnoses included bronchiolitis obliterans,
alveolar proteinosis, metastatic carcinoma, lymphoma, tuberculosis,
and bronchioloalveolar cell carcinoma. Although transbronchial lung
biopsy is useful in the diagnosis of many diffuse lung diseases, it
is not a replacement for open lung biopsy. When nonspecific findings
by transbronchial lung biopsy do not correlate with the clinical
picture, open lung biopsy should be performed.
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