Transbronchial Lung Biopsy

Curley, Frederick J.; Johal, Jasbir; Burke, M.; Fraire, Armando E.

doi:10.1378/chest.113.4.1037

Cited by 59 publications

(16 citation statements)

References 6 publications

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“…Although an adequate specimen is usually determined according to the appearance, colour, consistency and size, its definition remains somewhat arbitrary and subjective in our institution. However, previous work has demonstrated that a diagnostic biopsy specimen will likely be obtained if the size of the specimen fills the forceps [9] and this is in accordance with the adequacy criteria adopted by our pulmonologists. Moreover, a consistent judgment of the biopsy specimens was observed in our study because the diagnostic yield of the PPLs and the average diameter of the largest biopsy specimens were similar irrespective of the number of specimens.…”

Section: Discussionsupporting

confidence: 74%

Endobronchial Ultrasound-Guided Transbronchial Biopsy of Peripheral Pulmonary Lesions: How Many Specimens Are Necessary?

Huang

Tsai²,

Liao³

et al. 2012

Respiration

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Background: Although endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) has been shown to increase the diagnostic yield over conventional bronchoscopic techniques, an important issue regarding the optimal number of biopsy specimens required has not been thoroughly investigated. Objectives: We sought to examine whether the number of biopsy specimens taken was associated with the diagnostic yield of EBUS-guided TBB and, if this was the case, to determine the optimal number of specimens required for the maximum diagnostic yield in peripheral pulmonary lesions. Methods: The medical records of patients undergoing EBUS-guided TBB for the diagnosis of peripheral pulmonary lesions from 2008 to 2010 were retrospectively reviewed. The association of clinical and radiological features, including the number of biopsy specimens, with the diagnostic yield was analysed. Results: A total of 384 patients were included for analysis. The overall diagnostic yield of EBUS-guided TBB was 73%, and the only factor influencing the diagnostic yield was the position of the probe. Patients in which the EBUS probe was placed within the lesions had a significantly higher yield (85%) than those in which the probe was adjacent to or outside the lesions (38%; p < 0.001). When the number of biopsy specimens was determined based on their adequacy, it was an insignificant factor in predicting the diagnostic yield. Conclusions: Probe position independently predicts the diagnostic yield of EBUS-guided TBB. In real-world practice, the optimal number of biopsy specimens should be decided on a case-by-case basis.

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Section: Discussionsupporting

confidence: 74%

Endobronchial Ultrasound-Guided Transbronchial Biopsy of Peripheral Pulmonary Lesions: How Many Specimens Are Necessary?

Huang

Tsai²,

Liao³

et al. 2012

Respiration

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“…Curley et al . [326] showed that in 43 patients undergoing TBLB, alligator forceps retrieved larger pieces of tissue and was more likely to obtain diagnostic tissue than cup forceps, without any difference in the complication rate. On the contrary, a smaller study of 20 subjects reported higher tissue adequacy using large cup forceps than large alligator forceps.…”

Section: Bronchoscopic Samplingmentioning

confidence: 99%

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

et al. 2019

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Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.

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“…They recommend that at least five to six specimens per TBB should be taken, the optimal number of specimens to optimize the diagnostic yield being, however, seven to ten. Curley et al [58]reported that larger biopsy specimens were more likely to contain diagnostic tissue (r = 0.29, p = 0.001). Cup forceps retrieved smaller pieces of tissue (p = 0.007) and were less likely to obtain diagnostic tissue (p = 0.06).…”

Section: Immunocompetent Subjectsmentioning

confidence: 99%

Diagnostic Invasive Procedures in Diffuse Infiltrative Lung Diseases

Poletti¹,

Chilosi²,

Olivieri³

2004

Respiration

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The diagnosis of infiltrative diffuse lung disease may require invasive procedures after all noninvasive tools have failed. The clinical context in which these diseases develop and the radiological patterns are crucial for defining the timing and the methods to be used. Immunocompromised hosts are usually acutely ill with fever, cough, shortness of breath, and often with progressive hypoxemia. In this context a prompt diagnosis is necessary to decrease mortality. Bronchoalveolar lavage [especially in cases that show ground-glass attenuation or alveolar opacification in high-resolution CT scan (HRCT)] is the most important invasive procedure allowing the identification of infectious agents, neoplastic elements and characteristic cytological and phenotypical profiles (for drug injury) in the majority of cases. Less frequently transbronchial lung biopsy, transbronchial needle aspiration and biopsy or surgical lung biopsy are necessary. In immunocompetent patients the clinical spectrum of diffuse lung disease is quite broad. Furthermore, in the last two decades HRCT, used in conjunction with clinical and other noninvasive investigative modalities, has increased the accuracy of diagnosis for some diseases without the need of surgical biopsy. Also in these patients bronchoalveolar lavage, frequently in combination with transbronchial lung biopsy, is sufficient to achieve a definitive diagnosis in the majority of cases. Surgical lung biopsy is, however, still relevant in cases with idiopathic interstitial pneumonias. In this article invasive diagnostic procedures in patients with diffuse lung infiltrates are discussed from the perspective of their clinical context and their imaging characteristics.

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Transbronchial Lung Biopsy

Cited by 59 publications

References 6 publications

Endobronchial Ultrasound-Guided Transbronchial Biopsy of Peripheral Pulmonary Lesions: How Many Specimens Are Necessary?

Endobronchial Ultrasound-Guided Transbronchial Biopsy of Peripheral Pulmonary Lesions: How Many Specimens Are Necessary?

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

Diagnostic Invasive Procedures in Diffuse Infiltrative Lung Diseases

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