The Effect of Cup Versus Alligator Forceps on the Results of Transbronchial Lung Biopsy

Abstract

Transbronchial lung biopsy (TBLB) is a routine diagnostic procedure for pulmonary diseases and is performed by using either the alligator or cup forceps. The purpose of this study was to compare the role of the type of forceps in the quality and complications of TBLB. This was a prospective, observational, double-blinded study. Four samples were taken from each patient through TBLB. Characteristics of the samples, including sample size and number of alveoli, whether it was diagnostic or not, and side effects such as pneumothorax and bleeding, were all recorded. One hundred seventy-six biopsy samples obtained from 44 patients were evaluated; 21 patients (47.7%) were male. Of the 88 samples taken with an alligator forceps, based on size, 21.6% were small, 45.5% were medium, and 33% were large. Corresponding results for the samples taken with a cup forceps were 43.2% small, 29.5% medium, and 27.3% large. Of the 88 biopsy samples taken with an alligator forceps, 18.2% were diagnostic; this rate was 23.9% for cup forceps. Significant pneumothorax was not seen in any of the cases in the alligator forceps group, but it was detected in 9% of the cases in the cup forceps group. Significant bleeding was seen in 1% of the alligator forceps and 5.7% of the cup forceps procedures. Our study results, comparing the effect of 2 different kinds of forceps on TBLB results, were consistent with those of other studies with larger samples (P=0.008) using alligator forceps. The diagnostic value of the procedures was not significantly different (P=0.355).