Yield Of Transbronchial Lung Biopsy Research Articles

Comparison of the diagnostic yield of transbronchial lung biopsies by forceps and cryoprobe in diffuse parenchymal lung disease.

Transbronchial lung cryobiopsy (TBLC) in the diagnosis of diffuse parenchymal lung disease (DPLD) has shown a promising yield in recent times, with low post-procedural mortality and morbidity. To compare the yield of TBLC and conventional transbronchial forceps lung biopsy (TBLB). A prospective study was carried out in patients with DPLD over a period of 1 year in a tertiary respiratory care institute in New Delhi, India. All 87 patients enrolled underwent both TBLB and TBLC. The procedures were performed in the bronchoscopy suite under conscious sedation and local anaesthesia, with an attempt to take a minimum of three biopsy specimens by conventional TBLB followed by TBLC. A 1.9 mm cryoprobe with a freezing time of 4 - 5 seconds was used. An Arndt endobronchial blocker was used to control bleeding along with locally administered medications. TBLB and TBLC led to a definitive diagnosis in 27 (31.0%) and 69 (79.3%) cases, respectively. The commonest diagnoses were hypersensitivity pneumonitis, sarcoidosis and pulmonary tuberculosis. TBLC led to additional diagnoses in 42 cases (48.3%). Pneumothorax was observed in 12 cases (13.8%), and moderate bleeding occurred in 63 (72.4%). There were no procedure-related deaths. TBLC had a better diagnostic yield than conventional TBLB in DPLD. It has the potential to become a safe day-care procedure in a resource-limited setting, if certain precautions are taken. What the study adds. Compared with transbronchial forceps lung biopsy, transbronchial lung cryobiopsy (TBLC) led to additional diagnoses in 42 (48.3%) of 87 patients with clinicoradiological features of diffuse parenchymal lung disease. Pneumothorax was observed in 12 cases (13.8%) and moderate bleeding in 63 (72.4%). TBLC without rigid bronchoscopy or advanced airway devices under conscious sedation had a good diagnostic yield with an acceptable adverse events profile.Implications of the findings. TBLC under conscious sedation is not resource intensive and can be carried out in settings with limited resources.

Spectrum of Diffuse Parenchymal Lung Diseases Other Than Idiopathic Pulmonary Fibrosis Based on Clinical, Radiological and Histopathological Correlation

Background: Multiple modalities are available for diagnosis of diffuse parenchymal lung diseases. High-resolution roles computed tomography of lung was well established in formulating initial cases diagnosis with diffuse parenchymal lung diseases. Major utilities of transbronchial lung biopsy rests in making possibilities specific diagnosis diffuse parenchymal lung diseases cases and avoiding a surgical lung biopsy. Objectives and Methods: The aim of this work was to study the spectrum of diffuse parenchymal lung diseases other than idiopathic pulmonary fibrosis based on clinical, radiological and histopathological correlation. This study included 120patients with chest high resolution computed tomography signs of diffuse parenchymal lung diseases not consistent with idiopathic pulmonary fibrosis. Flexible bronchoscopy was done with the bronchoalveolar lavage and transbronchial lung biopsy were obtained. The samples were processed for cyto-histopathology. Results: Nodular pattern (73.33%) was the most high-resolution computed tomography (HRCT) predominant pattern followed by ground glass pattern (45%) and reticular pattern (26.67%). The most frequent diagnosis was sarcoidosis(40.83%) followed by hypersensitivity pneumonitis (20%). The overall diagnostic yield of transbronchial lung biopsy was 79.1% (95/120). All differential diagnoses showed extreme matching between HRCT and histopathology. Conclusion: HRCT is a non-invasive method to evaluate and diagnose patients with diffuse parenchymal lung diseases. Transbronchial lung biopsy found to have reliable yields in with diffuse parenchymal lung diseases diagnosis.

Improved diagnostic yield of transbronchial lung biopsy in peripheral pulmonary lesions using a combination of endobronchial ultrasound and rapid on-site evaluation

ObjectivesTo evaluate the value of rapid on-site evaluation (ROSE) during radial probe endobronchial ultrasound transbronchial lung biopsy (rpEBUS-TBLB) for peripheral pulmonary lesions (PPLs).MethodsOne hundred and six patients with PPLs who received rpEBUS-TBLB were enrolled in this study. One specimen was immediately examined by ROSE and the other was sent to the central laboratory for cytologic diagnosis. The results of ROSE were compared with those of pathological diagnosis.ResultsThe diagnostic accuracy, sensitivity, and specificity of ROSE during rpEBUS-TBLB for PPLs were 82.1%, 89.6%, and 77.1%, respectively. The procedure times and number of biopsies were less for procedures when ROSE was positive compared with those when ROSE was negative (procedure time: 20.5 ± 7.9 vs. 28.3 ± 7.6 minutes; number of biopsies: 1.6 ± 0.9 vs. 2.8 ± 0.6 times). No serious procedural complications were observed.ConclusionsROSE has value for diagnosing PPLs during rpEBUS. It can reduce procedure time, number of biopsies, and complications. ROSE combined with rpEBUS is an effective and safe method for the diagnosis of PPLs.

Diagnostic yield, safety, and impact of transbronchial lung biopsy in mechanically ventilated, critically ill patients: a retrospective study

BackgroundPulmonary infiltrates of variable etiology are one of the main reasons for hypoxemic respiratory failure leading to invasive mechanical ventilation. If pulmonary infiltrates remain unexplained or progress despite treatment, the histopathological result of a lung biopsy could have significant impact on change in therapy. Surgical lung biopsy is the commonly used technique, but due to its considerable morbidity and mortality, less invasive bronchoscopic transbronchial lung biopsy (TBLB) may be a valuable alternative.MethodsRetrospective, monocentric, observational study in mechanically ventilated, critically ill patients, subjected to TBLB due to unexplained pulmonary infiltrates in the period January 2014 to July 2019. Patients’ medical records were reviewed to obtain data on baseline clinical characteristics, modality and adverse events (AE) of the TBLB, and impact of the histopathological results on treatment decisions. A multivariable binary logistic regression analysis was performed to identify predictors of AE and hospital mortality, and survival curves were generated using the Kaplan-Meier method.ResultsForty-two patients with in total 42 TBLB procedures after a median of 12 days of mechanical ventilation were analyzed, of which 16.7% were immunosuppressed, but there was no patient with prior lung transplantation. Diagnostic yield of TBLB was 88.1%, with AE occurring in 11.9% (most common pneumothorax and minor bleeding). 92.9% of the procedures were performed as a forceps biopsy, with organizing pneumonia (OP) as the most common histological diagnosis (54.8%). Variables independently associated with hospital mortality were age (odds ratio 1.070, 95%CI 1.006–1.138; p = 0.031) and the presence of OP (0.182, [0.036–0.926]; p = 0.040), the latter being confirmed in the survival analysis (log-rank p = 0.040). In contrast, a change in therapy based on histopathology alone occurred in 40.5%, and there was no evidence of improved survival in those patients.ConclusionsTransbronchial lung biopsy remains a valuable alternative to surgical lung biopsy in mechanically ventilated critically ill patients. However, the high diagnostic yield must be weighed against potential adverse events and limited consequence of the histopathological result regarding treatment decisions in such patients.

Outcome of Transbronchial Lung Biopsy for Patients with Respiratory Symptoms

Background and objectives: Transbronchial lung biopsy was introduced into clinical practice as a diagnostic procedure in the evaluation of diffuse lung diseases and it is relatively noninvasive and safe to obtain tissue lung biopsies. Our aim was to evaluate this procedure for the diagnosis of patients with different lung pathologies. Methods: A prospective study of 50 cases with a variety of respiratory symptoms and chest imaging findings like mass lesions, infiltrations and consolidations, referred to our respiratory center from August 2017 to August 2018. Flexible bronchoscope and C-arm fluoroscope had been. Results: The most common radiological findings were consolidations (34%), masses (16%) and cavitation (10%). The diagnostic yield of Transbronchial lung biopsy was 50 % of the cases, 8 cases (16 %) out of these were mycobacterium tuberculosis, 6 cases (12%) were cryptogenic organizing pneumonia ,5 cases (10%) were bronchogenic carcinoma,3 cases (6%) were usual interstitial pneumonia, 1 case (2%) was anthracosis, 1 case (2%) was sarcoidosis and 1 case (2%) was silicosis. There were just two complications,1 case (2%) developed pneu- mothorax and another one (2%) developed surgical emphysema. Conclusions: Transbronchial lung biopsy is still a very useful safe and necessary procedure, In the absence of new technical procedures like endobronchial ultrasound or radial probe- endobronchial ultrasound, it remains an important step in the diagnosis of various lung diseases with minimal complication.

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Using 19-G Needle for Sarcoidosis.

Flexible bronchoscopy with endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is increasingly being used to obtain pathology specimens for diagnosis of sarcoidosis. There is wide variation in reported diagnostic yield in literature. New TBNA needles are available in the market but data are lacking about their diagnostic yield especially for sarcoidosis. This study reports the diagnostic yield of bronchoscopy with EBUS-TBNA using ViziShot FLEX 19-G needle in a series of patients with suspected sarcoidosis. This is a retrospective chart review for diagnostic yield of the 19-G EBUS-TBNA needle for suspected sarcoidosis. Eighty-six EBUS bronchoscopies were performed, 15 were done with clinical suspicion of sarcoidosis. The 19-G needle was used for all cases of suspected sarcoidosis. The procedure was diagnostic of sarcoidosis in 14 (93.3%) patients by TBNA with 1 nondiagnostic bronchoscopy. Procedural diagnostic yield was 93.3%. Eighty-five percent (28/33) of sampled lymph nodes were positive for noncaseating granulomas. The yield of transbronchial lung biopsy (TBLB) and endobronchial lung biopsy was 38% (5/13) and 43% (6/14), respectively. TBLB and endobronchial lung biopsy did not add to the diagnostic yield of the procedure. No significant adverse events were noted. This series reports a higher diagnostic yield than most other published studies and opens platform for direct comparison of each available needle. It also adds to the safety data for this larger needle. In addition, it raises doubt into utility of TBLB for diagnosis of sarcoidosis, which can increase the procedural complications.

Predictors of Successful Yield of Transbronchial Lung Biopsy in Patients With Sarcoidosis.

Transbronchial lung biopsy (TBLB) is an important bronchoscopic procedure used in the diagnosis of sarcoidosis. Only a few studies have evaluated determinants associated with successful diagnostic yield of TBLB. Herein, we evaluate the factors predicting successful yield of TBLB in subjects with sarcoidosis. Consecutive subjects with a clinical suspicion of sarcoidosis who underwent TBLB were enrolled. We evaluated the association between symptoms, spirometric lung function, radiologic stage of sarcoidosis, number of specimens, presence of floating biopsies, number of alveoli, and successful diagnostic yield (presence of granuloma) on TBLB. Of the 223 subjects, sarcoidosis was diagnosed in 209 [mean (SD) age, 43.9 (12.6) y; 50.7% men] individuals. A total of 1021 TBLB specimens were obtained. Granulomas were demonstrated in 123 (58.9%) subjects on TBLB. On a multivariate analysis, there was no association between successful diagnostic yield and the presence of dyspnea, spirometric lung function, radiologic stage of sarcoidosis, presence of floating biopsies, presence of at least 50 alveoli, or crush artifacts during histopathologic examination. Complications were encountered in 25 (11.9%) subjects. There were no deaths. TBLB is a reasonably safe procedure with a good diagnostic yield. The present study did not identify any predictors associated with successful diagnostic yield of TBLB in sarcoidosis.

Factors associated with the diagnostic yield of computed tomography-guided transbronchial lung biopsy.

BackgroundComputed tomography (CT) may be useful for increasing the diagnostic yield of transbronchial lung biopsy (TBLB). However, only a few studies with small sample sizes have reported the diagnostic utility of CT‐guided TBLB and the factors affecting the diagnostic accuracy of CT‐guided TBLB are not well known. We evaluated the diagnostic yield of CT‐guided TBLB and associated factors.Methods CT‐guided TBLB was performed in 59 patients. Both conventional fluoroscopy and CT were used in all patients for TBLB. The biopsy forceps were advanced toward the lesion under conventional fluoroscopic guidance. CT was used to check whether the forceps were in the correct position.ResultsThe average diameter of the lesions was 3.1 ± 1.0 cm. The biopsy forceps correctly reached the lesion in 43 patients by real‐time CT. A diagnosis was made in 42 patients, and the overall diagnostic yield was 71.2%. The sensitivity for malignancy was 85.7%. In multivariate analysis, the only factor associated with diagnostic yield was forceps position assessed by CT scan (adjusted odds ratio 53.31; 95% confidence interval 5.31, 535.27; P = 0.001).Conclusion CT‐guided TBLB is a useful diagnostic tool for pulmonary nodules or masses. The correct positioning of biopsy forceps using CT is valuable for successful CT‐guided TBLB.

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Increases the Yield of Transbronchial Lung Biopsy for the Evaluation of Peribronchial Lesions.

Background:Due to absence of visible endobronchial target, the diagnostic yield of flexible bronchoscopy for peribronchial lesions has been unsatisfactory. Convex probe endobronchial ultrasound (CP-EBUS) has allowed for performing real-time transbronchial needle aspiration (TBNA) of enlarged hilar and mediastinal lymph nodes and therefore could also be used as a means of diagnosing proximal peribronchial lesions.Methods:We retrospectively analyzed the results related to 72 patients who underwent CP-EBUS for peribronchial lesions without endobronchial involvement and adjacent to three-grade bronchi based on chest computed tomography (CT) scan. We recorded the images during EBUS as well as the diagnostic results of TBNA and conventional-transbronchial lung biopsy/brush (C-TBLB/b), and final diagnoses were based on pathologic analysis and follow-up.Results:In all cases, the mass was able to be identified using EBUS in 97.2% patients (70/72) who were performed with EBUS-TBNA + C-TBLB/b. Sixty-six patients had a final diagnosis, 80.0% patients (56/70) had malignancies, and 14.3% patients (10/70) had benign disease. In malignancies, the diagnostic yield of C-TBLB/b was 57.1% (32/56) and in EBUS-TBNA was 85.7% (48/56), whereas pathologic diagnosis reached 94.6% when EBUS-TBNA was combined with C-TBLB/b. C-TBLB/b + EBUS-TBNA also exhibited stronger potency of histolytic diagnosis for malignancies than either EBUS-TBNA or C-TBLB/b alone. Furthermore, there are data supporting the value of EBUS-TBNA for the diagnosis of benign lung disease.Conclusion:The combined endoscopic approach with EBUS-TBNA and C-TBLB/b is an accurate and effective method for the evaluation of peribronchial lesions, with better results than using each technique alone.

Lung cryobiopsies: a paradigm shift in diagnostic bronchoscopy?

In 1963, the first bronchoscopic lung biopsy was performed. Less than 10 years later, the technique of transbronchial lung biopsy using a flexible bronchoscope was introduced into clinical practice, significantly reducing the rate of major complications and the rate of surgical lung biopsies in patients with diffuse parenchymal lung diseases. The diagnostic yield of transbronchial lung biopsy varies among various parenchymal lung diseases. In pulmonary sarcoidosis and lymphangitis carcinomatosa, a diagnosis can be obtained in up to 80% of patients. This method is considered inadequate, however, in identifying more complex histological patterns such as usual interstitial pneumonitis or nonspecific interstitial pneumonitis. Introduction of the 'jumbo forceps' and of a more 'surgically oriented' procedural setting (patients deeply sedated and intubated) allowed larger and more numerous lung specimens to be obtained without a significant increase of complications such as pneumothorax or bronchial bleeding. However, the possibility to obtain enough parenchymal tissue for a morphological diagnosis of complex patterns remained unmet. Recently, the use of cryoprobes has achieved a significant impact on this issue allowing to obtain large quantity of tissue. Recent studies document that with transbronchial cryobiopsies the diagnosis of usual interstitial pneumonitis can be made confidently by pathologists with a good inter-observer agreement. Pneumothorax is the main complication (reported in up to one fourth of cases in some series); bronchial bleeding is easily controlled using Fogarty balloon. Transbronchial cryobiopsy is a promising new technique that may become a valid alternative to surgical lung biopsy in the near feature.

The effects of bronchoscope diameter on the diagnostic yield of transbronchial lung biopsy of peripheral pulmonary nodules.

BackgroundTransbronchial lung biopsy (TBLB) is a valuable diagnostic tool for peripheral pulmonary lesions. The diagnostic yield of TBLB reportedly ranges from 41%-60%. Many studies demonstrated the various factors that influence the yield of TBLB, including size, location, and distance from the carina or pleura. However, no study has evaluated the effects of the bronchoscope diameter. We evaluated whether the bronchoscope diameter affected the diagnostic yield of TBLB.MethodsWe reviewed records from 178 patients who underwent TBLB using bronchoscopes of two different diameters (5.7 mm, thick outer diameter, Olympus BF-200; 4.9 mm, thin, BF-260). The fluoroscopic guidance rates, yield of TBLB and flexible bronchoscopy (FB) were compared between the two groups. Additionally, we compared the results of the procedures with respect to diagnosis, distance from the pleura, and size of the lesion.ResultsThe results of fluoroscopic guidance, TBLB, and FB yield using thin diameter bronchoscope were significantly better than those obtained with a thick diameter bronchoscope (p=0.021, p=0.036, and p=0.010, respectively). Particularly, when the distance from the pleura was ≤ 10 mm, success rates for fluoroscopic guidance and FB with thin bronchoscope were higher (p=0.013 and p=0.033, respectively), as compared to with thick bronchoscope.ConclusionA thinner diameter bronchoscope increased the yield of bronchoscopy, and bronchial washing in conjunction with TBLB was useful in the diagnosis of peripheral pulmonary nodules.

Echoic Features as Predictors of Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Lung Biopsy in Peripheral Pulmonary Lesions

The endobronchial ultrasound (EBUS) features of peripheral pulmonary lesions (PPLs) are associated with histopathologic presentation. Certain histologic and radiologic characteristics of peripheral pulmonary lesions affect the diagnostic yield of transbronchial lung biopsies (TBLB). This study aimed to assess the feasibility of EBUS echoic features as predictors of diagnostic yield of TBLB. Four hundred and eight patients with PPLs underwent TBLB. The yields of TBLB in lesions with characteristic EBUS features were compared with those without such features. The overall diagnostic yield of TBLB was 64.2%. Lesion diameter (≥3 cm vs. <3 cm; 69.1% vs. 58.5%, p < 0.05), location of the EBUS probe (within vs. adjacent to lesions; 73.2% vs. 46.3%, p < 0.01) and lesion echogenicity (heterogeneous vs. homogeneous; 76.7% vs. 52.0%, p < 0.01) were associated with higher TBLB yields. In malignant PPLs, the echoic features associated with higher TBLB yields were lesion diameter (≥3 cm vs. <3 cm; 74.4% vs. 62.5%, p < 0.05), location of the EBUS probe (within vs. adjacent to lesions; 78.7% vs. 47.4%, p < 0.01), echoic feature of the margin (noncontinuous vs. continuous; 77.0% vs. 62.4%, p < 0.01) and lesion echogenicity (heterogeneous vs. homogeneous; 77.7% vs. 53.9%, p < 0.01). EBUS probe location, echoic feature of the margin and lesion echogenicity were independent predictors according to the results of multivariate analysis. In conclusion, EBUS features are feasible predictors of diagnostic yield of TBLB in peripheral lung lesions.

Diagnostic Yield of Flexible Bronchoscopy Without Fluoroscopic Guidance in Evaluating Peripheral Lung Lesions

Flexible bronchoscopy (FB) is frequently performed in patients with peripheral lung lesions. The aim of this study was to evaluate the diagnostic yield, factors affecting diagnostic yield, complications, and safety of FB without fluoroscopic guidance in patients with peripheral lung lesions. We retrospectively reviewed the medical records of all patients who underwent FB without fluoroscopic guidance for the diagnosis of peripheral lung lesions between 1999 and 2004. Ninety-three patients were enrolled. Among these, 38 lesions were malignant, 46 were benign, and 9 were indeterminate. The overall diagnostic rate was 65%, and the diagnostic sensitivities for malignant and benign lesions were 68% and 74%, respectively. The diagnostic yield was significantly higher for lesions >2 cm (70%) than for lesions ≤2 cm (11%; P <0.001). The diagnostic yield of transbronchial lung biopsy (46%) was higher than that of bronchial washing (29%; P=0.025) or brushing (29%; P=0.022). The yield of transbronchial lung biopsy for malignant disease (70%) was higher than that of benign disease (35%; P=0.003). Pneumothoraces and significant bleeding developed in 4.3% and 2.2% of patients, respectively. This study showed that FB sampling without fluoroscopic guidance was safe with a high rate of accuracy for the diagnosis of lung lesions not visible through a bronchoscope. When we performed a computed tomography scan and determined the exact location of the lesion before FB, the diagnostic yield of FB without fluoroscopic guidance was comparable with that reported earlier using fluoroscopy.

Transbronchial lung biopsy as a diagnostic method of peripheral lesions

The aim of the study was to assess the diagnostic yield of transbronchial lung biopsy (TBLB) without fluoroscopic guidance in peripheral lesions of diameter 2,5-6 cm. TBLB was performed in 65 consecutive patients without abnormalities in bronchial tree in standard bronchofiberoscopy and preceded by computed tomography (CT). The CT guidance helped to select the segment of lung to be biopsied. In 39 patients (60%) TBLB enabled to diagnose 36 cases of lung cancer, 2 cases of carcinoid and 1 case of malignant lymphoma. There were 26 cases (including 21 cases of lung cancer) undiagnosed by means of TBLB. In 24 patients the diagnosis was established by means of other methods like transbronchial needle aspiration (TBNA)--5 cases, thin needle biopsy (TNB)--12 cases, open lung biopsy (OLB)--7 cases and in the remaining 2 patients a regression of clinical and radiological features was observed. Transbronchial lung biopsy was found to be efficient diagnostic method in peripheral lesions higher than 2,5cm. However, in 40% of cases this technique doesn't allow to establish a diagnosis. This, in turn implicates the necessity for further diagnostic procedures including TBNA, TNB or even OLB.

Transbronchial lung biopsy as a diagnostic method of diffuse pulmonary diseases

The aim of the study was to assess the diagnostic yield of transbronchial lung biopsy (TBLB) in some of diffuse pulmonary diseases, like: sarcoidosis, organizing pneumonia--(OP), tuberculosis and neoplasmatic infiltrates of the lung. Transbronchial lung biopsy was performed in 123 patients, preceded by high resolution computed tomography (HRCT). The HRCT guidance helped to select the area of lung to be biopsied. In 80 patients (65%) TBLB enabled to diagnose 40 cases of sarcoidosis, 15 cases of OP, 13 cases of neoplasmatic infiltrates of the lung and 5 cases of tuberculosis. There were 43 cases undiagnosed by means of TBLB. In 19 patients the diagnosis was established by means of other methods like videothoracoscopy (8 cases), bronchoscopy with bronchial mucose biopsy (7 cases of sarcoidosis), mediastinoscopy (2 cases of Hodgkin's disease), transthoracic needle biopsy (2 cases of adenocarcinoma). Moreover sarcoidosis was diagnosed in 15 cases by means of clinical, radiological examination and BAL. 9 patients didn't agree for further invasive diagnostics. Transbronchial lung biopsy was shown to be efficient diagnostic method especially in sarcoidosis, OP and neoplasmatic infiltrates of the lung. However, in approximately 35% of cases of diffuse pulmonary diseases this technique doesn't allow to establish a diagnosis. This in turn implicates the necessity for further diagnostic procedures including videothoracoscopic or open lung biopsy.

Endobronchial Ultrasound (EBUS) guided transbronchial lung biopsy (TBB) in fluoroscopic invisible solitary pulmonary nodules (SPN) –a prospective trial

PURPOSE: Transbronchial biopsy for SPN is usually performed under fluoroscopic guidance. Depending on the size, nodules smaller than 3 cm are often fluoroscopically invisible and the yield of TBB may drop dramatically. EBUS allows visualisation of small nodules. The study aimed to asses the yield of EBUS guided TBB in fluoroscopic invisible solitary pulmonary nodules.

Bronchoscopic Diagnosis of Solitary Pulmonary Nodules and Lung Masses in the Absence of Endobronchial Abnormality

To evaluate the individual and additive diagnostic yield(s) of several bronchoscopic sampling techniques for the diagnosis of lung lesions with no corresponding airway abnormalities, consecutive patients with lung nodules or masses were prospectively evaluated between December 1989 and November 1994. A CT of the chest was done in all patients before flexible bronchoscopy (FB). Size, location, and character of the border of the lesion were determined. During FB, using biplane fluoroscopic guidance, the lesion was localized and following sampling techniques were done: brushing, transbronchial lung biopsy (TBLB), and Sofcor transbronchial needle aspiration (STBNA). Bronchial washings (BWs) were collected throughout the procedure. Problems associated with each sampling technique were noted. Forty-nine patients underwent 51 FB. A diagnosis was established by FB in 36 (73%). After a nondiagnostic FB, histologic diagnosis was established in 9 of 13 patients by other methods. A benign or malignant nature of lesion was established in other four patients by clinical follow-up. FB was diagnostic in 32 of 40 (80%) patients with primary lung cancer, in 3 of 6 (50%) patients with benign disease, and in 1 of 3 (33%) patients with metastatic disease to lung. All sampling procedures could be done in 33 of 51 (65%) FBs. Overall diagnostic yields were as follows: BW, 18 of 51 (35%); brush, 25 of 48 (52%); TBLB, 23 of 40 (57%); and STBNA, 19 of 37 (51%). In 12 of 51 (24%) FBs, only one sample was diagnostic. Lesions with sharp borders had a lower combined diagnostic yield, 13 of 24 (54%) compared to lesions with fuzzy borders, 20 of 24 (83%) (p=0.03). Yield of TBLB in lesions with fuzzy borders, 14 of 18 (78%), was higher than the yield for lesions with sharp borders, 6 of 19 (32%) (p=0.005). Size of the lesion in centimeters in patients with a positive FB (4.55+/- 2.35; mean +/-SD) was significantly larger than in patients with a nondiagnostic FB (3.14+/-1.31; mean+/-SD) (p=0.009, t test). Diagnostic yield was directly related to the size of the lesion. For lesions less than 2 cm, yield was 6 of 11 (54%) (p=0.19); for lesions less than 3 cm, yield was 12 of 21 (57%) (p=0.07); and for lesions greater than 3 cm, yield was 24 of 30 (80%). Yield from lesions located in the lower lobe basal segments or the apical segment of upper lobes was lower (11/19, 58%) than that from lesions in other parts of the lung (25/30, 83%) (p=0.05). FB was terminated prior to collecting all samples because of severe bleeding after brushing (n=3) or instability of the patient (n=4). None of the patients required intubation. There were no pneumothoraces. Diagnostic yield of FB depends on the location, size, character of the border of the lesion, and the ability to perform all sampling methods. Brushing, TBLB, and STBNA should be performed in all patients to give the best diagnostic yield. Routine cytologic examination of BW is unnecessary. Methods other than FB should be considered for lesions 2 cm or less in size, especially when they have a sharp border and/or are located in the basal segment of a lower lobe/apical segment of an upper lobe.

Diagnostic value of transbronchial lung biopsy under fluoroscopic guidance in solitary pulmonary nodule in an endemic area of tuberculosis

In the endemic area of tuberculosis, there are many cases that present tuberculosis as a solitary pulmonary nodule (SPN) on chest radiographs. The objective of this study is to evaluate the diagnostic yield of transbronchial lung biopsy (TBLB) under fluoroscopic guidance in SPNs such as lung cancer or pulmonary tuberculoma in areas with high prevalence of tuberculosis. One hundred and seventy patients with SPNs on chest radiographs were included in the study; all had negative sputum smears for tubercle bacilli and no malignancy by sputum cytology before bronchoscopy. Transbronchial lung biopsy and brushing were performed, routinely, under fluoroscopic guidance. Of 170 patients, 120 (70·6%) had lung cancer (including three with metastatic cancer), 40 (23·5%) patients had pulmonary tuberculosis (Tb), and the remaining 10 (5·9%) patients had other benign pulmonary lesions. The overall diagnostic rate in SPNs was 62·4% (106 of 170). Transbronchial lung biopsy and brushing revealed a diagnostic sensitivity of 70·0% in lung cancer (84 of 120) and a sensitivity of 55% in Tb (22 of 40). In addition, TBLB and brushing also provided rapid microscopic identification of Tb in 18 of 40 patients (45%, including 15 by TBLB, one by brushing smear, and two by postbronchoscopic sputum). The percentage of positive diagnosis correlated with diameter of the SPN. Solitary pulmonary nodules with diameter less than 2 cm were diagnosed in only 35·3% of cases (6 of 17; cancer 40% vs. Tb 29%). In contrast, the diagnostic rates in SPNs with diameters 2–4 cm and greater than 4 cm were 64·5% (78 of 121; cancer 72·0% vs. Tb 62·5%) and 68·8% of cases (22 of 32), respectively. Diagnostic bronchoscopy under fluoroscopic guidance is a useful tool in evaluation of patients with a peripheral pulmonary nodule since it may provide additional information to minimize unnecessary thoracotomy and give way for proper medication as early as possible.

Efficacy of 67Ga-Scintigraphy in Predicting the Diagnostic Yield of Transbronchial Lung Biopsy in Pulmonary Sarcoidosis

Nineteen consecutive patients with clinically suspected sarcoidosis underwent 67Ga-scintigraphy prior to transbronchial lung biopsy (TBLB) to determine if 67Ga uptake in lung parenchyma would increase the diagnostic yield of the biopsy procedure. Biopsies were obtained from the areas showing parenchymal uptake on the 67Ga scan in 13 of the 19 patients. In the six patients not demonstrating uptake of 67Ga in the lung parenchyma, biopsies were obtained at random from the right lower lobe. There was no correlation between 67Ga uptake in hilar nodes or pulmonary parenchyma tissue and the diagnostic yield from TBLB. We conclude that 67Ga scanning is neither efficacious nor cost-effective in predicting the diagnostic yield of TBLB in sarcoidosis.