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Transbronchial biopsy in usual interstitial
pneumonia.Chest.
2006 May;129(5):1126-31.
BACKGROUND:
Usual interstitial pneumonia (UIP) is a slowly progressive, usually
fatal form of idiopathic interstitial pneumonia for which there is
no effective treatment. Transbronchial biopsy (TBB) has been
utilized only to exclude other diseases such as sarcoidosis,
lymphangitic carcinoma, and infection, for example, but TBB is
generally considered to have little role in confirming UIP.
OBJECTIVE: To determine whether diagnostic changes of UIP can be
appreciated on TBB specimens. DESIGN: Retrospective analysis of TBB
specimens from patients with proven UIP. SETTING: Two study sites in
the United States. PARTICIPANTS: Twenty-one patients with UIP
confirmed by surgical lung biopsy and/or lung explant, and 1 patient
with UIP confirmed by clinical and radiographic findings along with
follow-up information. MEASUREMENTS AND RESULTS: Adequate tissue for
diagnosis was available in 18 cases; in 7 cases (32% overall), there
were varying combinations of interstitial fibrosis in a patchwork
pattern along with fibroblast foci and/or honeycomb change. These
features were considered diagnostic of UIP. Interstitial fibrosis
along with fibroblast foci or honeycomb change were seen in two
other cases, but the fibrosis lacked a patchwork pattern, and these
features were considered consistent with UIP. Nonspecific
interstitial fibrosis alone was found in nine cases. CONCLUSIONS: In
summary, characteristic histologic features of UIP can be identified
on TBB specimens more often than previously appreciated. TBB may be
more useful in confirming UIP than previously recognized.
Surveillance
transbronchial biopsy in the diagnosis of acute lung rejection in
heart and lung and lung transplant recipients.Monaldi
Arch Chest Dis. 1996 Feb;51(1):12-5.
From March 1991
to December 1993, 30 patients underwent transbronchial biopsy (TBB)
after lung transplantation (16 with a heart lung transplant, 7 with
a single lung transplant, and 7 with a double lung transplant). The
now standard TBB technique was used. Initially, TBB was performed
only when clinically indicated, i.e. when there were sound reasons
to suspect the existence of acute rejection (AR) or pulmonary
infection. From 1992, all the patients were entered into a
prospective study, the protocol of which called for serial
"surveillance" TBB to be performed, in addition to those for
clinical indications, 15 days, 2, 3, 6, 9 and 12 months after the
transplant, and then annually. One hundred and twenty nine
transbronchial biopsies were performed in 2.5 yrs. Of the 121
successful TBBs, 54 (45%) were positive, i.e. showed signs of acute
rejection. Sixty six of 129 (51%) of the TBBs were performed because
of clinical indications, 45 of them (68%) within the first 3 months
following the transplant. The other 63 were surveillance biopsies.
About two thirds of the clinically indicated TBBs and more than a
quarter of the surveillance TBBs, yielding adequate samples, were
positive for AR > or = A2 (mild rejection). The sensitivity and
specificity of the method in detecting AR were 91 and 100%,
respectively. The overall incidence of complications was 10.8% (pneumothorax
in 9% of cases). There were no deaths correlated to the procedure.
Our results confirm the decisive role of TBB in the diagnosis of
acute lung rejection. The high incidence of mild acute rejection,
and the occasional finding of moderate acute rejection in stable
asymptomatic patients, support the use of surveillance TBB in the
first 6 months.
Interpretation of
tissue artifacts in transbronchial lung biopsy specimens. Ann
Diagn Pathol. 2003 Feb;7(1):20-4
Proper
interpretation of transbronchial biopsies is critical for
appropriate patient management. Artifacts in lung tissue acquired
during the biopsy procedure or subsequent processing may mimic
"true" disease and potentially lead to incorrect diagnoses. In this
study the interpretation of various artifacts in transbronchial
biopsies will be correlated with the level of pathologist training
and experience. Minced 1 to 2 mm fragments of normal lung tissue
were processed to produce various tissue artifacts (atelectasis,
sponge artifact, or bubble artifact). Seven hematoxylin-eosin-stained
slides of various artifacts and three similar-appearing slides from
"true" pulmonary diseases (lipoid pneumonia, usual interstitial
pneumonia, and foreign body reaction) were evaluated by eight
pathologists of different levels of training and experience. Most
pathologists were unaware of the various artifacts in transbronchial
biopsies and were occasionally able to differentiate them from true
disease. Senior faculty frequently identified and correctly
diagnosed the true pathology slides; however, they often failed to
recognize artifacts. Junior faculty performed the best by correctly
identifying the majority of true pathology and dismissed most
artifacts. Junior and senior residents described the microscopic
changes, but had more difficulty determining the significance of
both true pathology and artifacts. Various artifacts in
transbronchial biopsy specimens can create diagnostic dilemmas for
all pathologists regardless of level of training. The elimination of
these artifacts should reduce the possibility of biopsy
misinterpretation.
Effectiveness of transbronchial needle aspiration in the diagnosis
of exophytic endobronchial lesions and submucosal/peribronchial
diseases of the lung.Lung
Cancer. 2005 Nov;50(2):221-6. Epub 2005 Jul 19
The role of
transbronchial needle aspiration (TBNA) in diagnosing endobronchial
lung cancers has not been elucidated. The definitive combination of
procedures that offers the best diagnostic yield following
fiberoptic bronchoscopy remains controversial. This study was
designed to investigate the diagnostic yield of transbronchial
needle aspiration and other cytologic and histologic diagnostic
procedures (i.e., forceps biopsy, brushing, and washing) and to
assess the optimal combination for diagnosing endobronchial lung
cancers. This prospective study included 95 patients presenting with
visible tumors detected during bronchoscopic procedure as either an
exophytic endobronchial lesion (EEL) or submucosal-peribronchial
disease (SPD). Transbronchial needle aspiration, forceps biopsy,
brushing, and washing were performed in all patients, and 91
patients were diagnosed. Rates of positive results were 75.8% for
needle aspiration, 71.6% for forceps biopsy, 61.1% for brushing, and
32.6% for washing. Needle aspiration was used as the sole diagnostic
method in 11, forceps biopsy was the sole diagnostic method in 5,
and brushing was the sole diagnostic method in 4 patients. Washing
was not used as the sole diagnostic method in any case. Forceps
biopsy yielded the highest diagnostic rate for an EEL (86.4%);
however, when compared with needle aspiration (77.9%), no
significant difference was observed between these two procedures (P
= 0.302). In patients with a diagnosis of SPD, needle aspiration was
determined to be the sole diagnostic method in eight patients. In
this group of patients, the highest rate of diagnosis was achieved
with needle aspiration (72.2%), and when compared with forceps
biopsy (47.2%), a significant difference between the two procedures
(forceps biopsy versus needle aspiration) was observed (P = 0.049).
By adding transbronchial needle aspiration to the conventional
diagnostic methods (forceps biopsy, brushing, and washing), the rate
of diagnosis increased from 82.1% to 95.8% (P = 0.001), and in
patients with a diagnosis of SPD, this rate increased from 69.4% to
94.4% (P = 0.008). In patients with a diagnosis of an EEL, addition
of needle aspiration led to an increase in diagnostic yield but this
difference was not statistically significant (89.8% versus 96.6%, P
= 0.250). In endobronchial lung cancers, transbronchial needle
aspiration is a safe method that can be used together with
conventional diagnostic procedures to increase the diagnostic yield
and should be considered a valuable diagnostic tool, particularly in
cases of SPD. The highest rate of diagnostic yield in this study was
obtained using a combination of forceps biopsy, transbronchial
needle aspiration, and brushing; washing did not contribute to this
high rate.
Transbronchial
needle aspiration. Rev
Port Pneumol. 2005 May-Jun;11(3):307-19.
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. The yield of this technique
published in the literature makes it more than useful. The material
available has different indications and usefulness in different
clinical settings. Despite the almost absence of complications this
procedure is yet underutilized, in spite of its twenty years of
results which may be due to the established routines and the lack of
training.
The role of transbronchial biopsy for the
diagnosis of diffuse pneumonias in immunocompromised marrow
transplant recipients.
Am Rev
Respir Dis. 1982 Nov;126(5):763-5.
We studied the
use of transbronchial biopsy for the diagnosis of diffuse pneumonia
in marrow transplant recipients. Transbronchial biopsy results were
directly compared with open-lung biopsy results by performing the
procedures simultaneously in the same lobe of the lung and
processing the specimens in parallel. There were 24 cases of
pneumonia diagnosed in 22 patients. Transbronchial biopsy correctly
identified 3 of 5 cases of Pneumocystis carinii and none of the 5
cases of viral pneumonia. The overall sensitivity of transbronchial
biopsy was 58%, with a 13% incidence of moderate hemorrhage and no
deaths. We conclude that the open-lung biopsy remains the procedure
of choice for the diagnosis of acute, diffuse pneumonia in the
immunocompromised marrow transplant recipient.
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