Comparison of Hot Versus Cold Biopsy Forceps in the Diagnosis of Endobronchial Lesions

Abstract

Introduction Traditionally cold biopsy forceps were used for endobronchial biopsy, and recently electrocautery (hot) bronchoscopy biopsy forceps are introduced. It is hypothesized that hot biopsy forceps may decrease procedure-related bleeding and also may decrease the quality of obtained samples. Patients and methods Patients with different indications for endobronchial biopsy during fiberoptic bronchoscopy underwent three hot and three cold biopsies with a random fashion. All biopsies were obtained with a single biopsy forceps with and without the application of an electrocoagulation current, set on soft coagulation mode (40 W). A four point scale was used for the quantification of bleeding. A single pathologist blinded to the patients’ history was requested to review all samples. A three point scale was used to assess electrocoagulation damage. Results A total of 240 biopsies were obtained from 40 patients. Frequency of positive concordance between the two methods was 85%. The degree of electrocoagulation damage of the samples was as follows: grade 1 =52.5%, grade 2 =32.5%, and grade 3 =15%. The average bleeding score following hot biopsy was significantly lower compared to the cold biopsy ( P=.006). The concordance between diagnostic yield of hot and cold biopsies was 85%. There was no significant difference between the diagnostic yields of two biopsy methods ( P=.687). Conclusions Hot biopsy forceps significantly decreased the procedure related bleeding. The quality of samples was not impaired significantly. Regarding low prevalence of bleeding following endobronchial biopsy, routine use of hot bronchoscopy forceps is not reasonable. However, familiarity of bronchoscopists with this method may improve bronchoscopy safety.