Complications and predictors of diagnostic yield of endobronchial forceps biopsy in visible lesions

Abstract

Background: Fiberoptic bronchoscopy is an important and relatively safe procedure for evaluation of various pulmonary diseases. Endobronchial forceps biopsy is commonly performed sampling technique for visible lesions in tracheobronchial tree. Diagnostic yield of biopsy depends upon lesion type and the number of biopsy samples taken. This study aimed to evaluate the complications and diagnostic yield of endobronchial forceps biopsy in visible lesions and correlate the number of biopsy samples taken with the yield.
 Methods: This was an observational study conducted at two tertiary care hospitals in Chitwan; Chitwan Medical College Teaching Hospital and B P Koirala Memorial Cancer Hospital. One hundred and forty patients who underwent endobronchial forceps biopsy of bronchoscopically visible lesions were included. Complications and diagnostic yield of the biopsy samples and its correlation with number of biopsies taken were evaluated.
 Results: The common complications observed were transient drop in saturation > 4% (22%) and mild bleeding (9.9%). The net diagnostic yield was 67.4% that significantly improved with an increase in the number of biopsies taken. The yield was better for exophytic growths compared to submucosal/ mucosal lesions (83.7% vs. 57%, OR = 8.1 (2.2 – 29.9), P<0.001). The association of improved yield with increased number of biopsy was more pronounced in exophytic growths compared to submucosal/mucosal lesions.
 Conclusion: Endobronchial forceps biopsy is a safe procedure that gives a good diagnostic yield in bronchoscopically visible lesions, provided adequate number of biopsy sample are taken. The probability of getting a positive yield is high in exophytic growths.

Bronchoscopy findings in 1074 lung cancer patients in a tertiary care center in Nepal

“…The diagnostic yield of the EBB varies from 48 to 93%. 8 The overall diagnostic yield was 68.4% which is similar to the study by Shrestha BK et al 14 and Rivera MP et al 15 but it is lower than the study by Zavala DC 16 and Popp W et al 17 British Thoracic Society guidelines recommends diagnostic level of 85% should be attainable when definite endobronchial tumor is visible. In the current study, the diagnostic yield of EBB was 75% despite repeated biopsies were taken in 21.2% of cases, which is below the recommended level.…”

“…Shrestha BK et al 14 reported mild bleeding of 9.9% in recent study, which may be higher due to EBB. The transient hypoxemia was seen in 18.4% and most of them did not require any specific intervention as stated by Jones A.…”

“…Only few studies have been done on the diagnostic yield of EBB for diagnosis of lung cancer. 4,14 Although this study had a large sample size, limitations are retrospective study, lack of data on other modalities like bronchoalveolar lavage and brush biopsy, lack of description of visible lesion and number of biopsies taken, and lack of immunohistochemistry for subtyping the morphologically undifferentiated NSCLC.…”

Thoracoscopic biopsy in the diagnosis of lung and pleural diseases

“…We had previously reported our experience in a small cross sectional study where the results were similar. 10 The limitation of the study is its retrospective nature and relatively small sample size.…”