Abstract
The recent introduction of bronchoscopically recovered cryobiopsy of lung tissue has opened up new possibilities in the diagnosis of neoplastic and non-neoplastic lung diseases in various aspects. Most notably the morphological diagnosis of peripheral lung biopsies promises to achieve a better yield with a high quality of specimens. To better understand this phenomenon, its diagnostic options and perspectives, this study morphometrically compares 15 cryobiopsies and 18 transbronchial forceps biopsies of peripheral lung tissue a priori without considering clinical hit ratio or integration of results in the clinical diagnostic processing. Cryotechnically harvested specimens were significantly larger (mean: 17.1 ± 10.7 mm2 versus 3.8 ± 4.0 mm2) and contained alveolar tissue more often. If present, the alveolar part in cryobiopsies exceeded the one of forceps biopsies. The alveolar tissue of crybiopsy specimens did not show any artefacts. Based on these results cryotechnique seems to open up new perspectives in bronchoscopic diagnosis of lung disease.
Highlights
The diagnostic yield of transbronchial lung biopsy (TBB) by forceps is a function of biopsy quality defined by specimen size and preservation of tissue architecture
Morphometric data of all samples including presence of alveolar part, its size and artefacts within alveolar tissue are listed in tables 1 and 2, and representive specimens retrieved with the two methods under comparison are illustrated in Figure 2 and 3
In specimens with alveolar tissue, its size was significantly larger in the cryobiopsies (11.6 ± 9.1 μm2 versus 1.9 ± 1.6 μm2 in the forceps group, n = 11 and 10 respectively; p = 0.004) (Figure 3)
Summary
The diagnostic yield of transbronchial lung biopsy (TBB) by forceps is a function of biopsy quality defined by specimen size and preservation of tissue architecture. It is difficult to report the diagnostic accuracy of TBB, because they are taken for various indications. The majority of large case series report a diagnostic accuracy of 50% to 70% depending on the indication, size and location of the lesion [1,3,5,6,7,8,9,10]. The results in usual interstitial pneumonia, pneumoconiosis or pulmonary histiocytosis X are poor [1,4,10,12]. This large variation is due to the different importance of alveolar tissue which is usually underrepresented in TBB.
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