Use and Abuse of Lung Biopsy

Gal, Anthony A.

doi:10.1097/01.pap.0000175116.40294.83

Cited by 19 publications

(9 citation statements)

References 71 publications

(76 reference statements)

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“…Whereas malignancy, sarcoidosis and post-transplant pathologic processes are often reliably diagnosed with TBLB, the diagnostic yield is lower for drug toxicity, hypersensitivity pneumonitis, and certain interstitial lung diseases [Usual Interstitial Pneumonia (UIP) and non-specific interstitial pneumonia (NSIP)]. (12) On the other hand, surgical lung biopsies have higher morbidity. Kreider, et al detailed a 10.7% incidence of hospital re-admission, 5.9% incidence of postoperative mechanical ventilation, 4.4% incidence of mortality, and 19.1% overall incidence of complications following VATS for ILD.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Transbronchial and Cryobiopsies in Evaluation of Diffuse Parenchymal Lung Disease

Ramaswamy

Homer²,

Killam³

et al. 2016

Journal of Bronchology &Amp; Interventional Pulmonology

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Background Diffuse parenchymal lung diseases (DPLDs) are common. An accurate diagnosis is essential due to differences in etiology, cli nicopathologic features, therapeutic options and prognosis. Transbronchial lung biopsies (TBLB) are often limited by small specimen size, crush artifact and other factors. Transbronchial lung cryobiopsies (TBLC) are under investigation to overcome these limitations. Methods We conducted a retrospective study of 56 patients in a single, tertiary-care academic center in order to compare the yield of both techniques when performed in the same patient. Patients underwent flexible bronchoscopy using moderate sedation with TBLB followed by TBLC in the most radiographically abnormal areas. Clinical data and post-procedural outcomes were reviewed, with a final diagnosis made utilizing a multidisciplinary approach. Results The mean age was 60 and 53.6% were male. Co-morbidities included COPD (14%) and prior malignancy (48%). The number of TBLB specimens ranged from 1–10 per patient (mean 4) and size varied from 0.1–0.8 cm. The number of TBLC specimens ranged from 1–4 per patient (mean 2) and size ranged from 0.4–2.6 cm. Both techniques provided the same diagnosis in 26 patients (46.4%). An additional 11 (19.6%) patients had a diagnosis established by adding TBLC to TBLB. Compared to TBLB, TBLC had a higher diagnostic yield in patients with hypersensitivity pneumonitis and interstitial lung disease. Only two patients required video-assisted thoracoscopic surgery (VATS) to establish a diagnosis. Complications included pneumothorax (19.6%) and massive hemoptysis (1.8%). Conclusions TBLC used with TBLB can improve the diagnostic yield of flexible bronchoscopy in patients with DPLD.

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Section: Discussionmentioning

confidence: 99%

Comparison of Transbronchial and Cryobiopsies in Evaluation of Diffuse Parenchymal Lung Disease

Ramaswamy

Homer²,

Killam³

et al. 2016

Journal of Bronchology &Amp; Interventional Pulmonology

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“…TBLBs are only likely to yield specific diagnoses in cases whereby small specimens are expected to be diagnostic, and particularly in forms of ILD with bronchocentric involvement [20]. For instance, a much larger size of specimen than that obtained by a TBLB, is normally required to make the diagnosis of UIP [21,22]. …”

Section: Discussionmentioning

confidence: 99%

The efficacy of video-assisted thoracoscopic surgery lung biopsies in patients with interstitial lung disease: a retrospective study of 66 patients

Morris

Zamvar

2014

J Cardiothorac Surg

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BackgroundDiagnosing a specific type of Interstitial Lung Disease (ILD) is a challenging process and often necessitates that a Video-assisted Thoracoscopic Surgery (VATS) Lung Biopsy be performed. By analysing the proportion of patients who have their treatment changed after undergoing a VATS lung biopsy, this study aimed to determine the utility of performing this procedure in patients with ILD.MethodsThe clinical data from sixty-six patients with suspected ILD, who underwent VATS lung biopsies at the New Royal Infirmary of Edinburgh (NRIE) in the period of 16th May 2011 – 11th February 2013, were analysed retrospectively. The main outcome measures considered in this study were: CT scan differential diagnoses, VATS lung biopsy histological differential diagnoses, post-VATS lung biopsy consensus diagnoses, 30-day mortality, surgical complications (minor and major), resultant changes in treatment and responses to these changes in treatment.ResultsFollowing VATS biopsy a definite pathological diagnosis was made in 74.2% of cases. A change in treatment was initiated in 47.2% of patients, including in 80% of patients diagnosed with Hypersensitivity Pneumonitis and 60% of patients diagnosed with sarcoidosis. A positive response to treatment was experienced in 58% of patients whom underwent a change in treatment. Only 54% of patients who received a consensus diagnosis of UIP after VATS lung biopsy, had been given a differential diagnosis of “probable UIP” at CT scan. 15% of patients who received a differential diagnosis of “probable UIP” at CT scan, had their diagnosis changed to Hypersensitivity Pneumonitis after lung biopsy. There was one mortality (1.5%) in this series of patients and no other major complications. Minor complications to surgery were experienced in 28.8% of patients.ConclusionsThis study highlights the effectiveness of performing VATS lung biopsies in patients with suspected ILD. The procedure leads to a change in treatment in almost half of all patients, including in the vast majority of cases of Hypersensitivity Pneumonitis. It also prevents what would be the inappropriate over-treatment of UIP. It has been shown to be a relatively safe procedure and thus, should be performed in all patients with suspected ILD, indeterminate in type from prior CT imaging.

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“…Pleuroscopy gives the unique opportunity to inspect the whole lung, choose the biopsy areas carefully and take biopsies from several lobes. However, in patients with fibrotic lungs, biopsies taken from areas with honeycombing are seldom informative, as the findings might be common to a variety of lung parenchyma disorders, irrespective of underlying etiology [24]. At the same time, biopsying fibrotic areas might expose the patient to prolonged air leak with significant impact on the hospital stay due to prolonged drainage [21,24].…”

Section: Discussionmentioning

confidence: 99%

“…However, in patients with fibrotic lungs, biopsies taken from areas with honeycombing are seldom informative, as the findings might be common to a variety of lung parenchyma disorders, irrespective of underlying etiology [24]. At the same time, biopsying fibrotic areas might expose the patient to prolonged air leak with significant impact on the hospital stay due to prolonged drainage [21,24]. Besides, given the high diagnostic accuracy of HRCT in the recognition of fibrotic patterns, especially usual interstitial pneumonia (UIP), a lung biopsy is not necessary for diagnosis [17,19,20,25].…”

Section: Discussionmentioning

confidence: 99%

Subpleural versus Deep Lung Biopsies Obtained during Pleuroscopy for Histological Examination: An Experimental Animal Study

Emam

Froudarakis²,

Refaat³

et al. 2012

Respiration

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Background: Lung biopsies obtained during medical pleuroscopy using coagulating forceps could represent a cost-effective alternative to surgical lung biopsies in patients with diffuse parenchymal lung diseases (DPLD). However, it is not clear whether these patients should undergo deeplung biopsies rather than more superficial subpleural lung biopsies. Objectives: The aim of this experimental animal study was to compare gross and microscopic features of deep and subpleural pleuroscopic lung biopsy samples. Methods: Six male sheep (median weight 40 kg) underwent lung biopsies via pleuroscopy under general anesthesia. The following parameters were studied: weight, size, quality of the parenchyma and visceral pleura, parenchymal vessels and bronchial tissue. Results: The mean number of biopsies taken per animal was 4.5 ± 1.22 and 4.83 ± 1.33 (p = 0.36) for deep and subpleural biopsies, respectively. The mean size of deep and subpleural biopsies was 1.758 ± 0.478 and 1.283 ± 0.851 cm², respectively (p = 0.0006). The mean weight of deep biopsies and subpleural biopsies was 0.156 ± 0.092 and 0.145 ± 0.047 mg, respectively (p = 0.83). No statistically significant difference was found between subpleural and deep biopsies regarding the mean quality scores of parenchyma-pleura (p = 0.36), vessels (p = 0.36), or bronchial tissue (p = 0.20). Conclusion: Both subpleural biopsies obtained during pleuroscopy and deep lung biopsy specimens obtained by electrocautery in animal subjects provided satisfactory material for histologic examination. Therefore, in DPLD, where the subpleural layers are involved, subpleural biopsies obtained during pleuroscopy might be sufficient for establishing an accurate diagnosis.

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Use and Abuse of Lung Biopsy

Cited by 19 publications

References 71 publications

Comparison of Transbronchial and Cryobiopsies in Evaluation of Diffuse Parenchymal Lung Disease

Comparison of Transbronchial and Cryobiopsies in Evaluation of Diffuse Parenchymal Lung Disease

The efficacy of video-assisted thoracoscopic surgery lung biopsies in patients with interstitial lung disease: a retrospective study of 66 patients

Subpleural versus Deep Lung Biopsies Obtained during Pleuroscopy for Histological Examination: An Experimental Animal Study

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