Comparison of Transbronchial Lung Biopsy Yield between Standard Forceps and Electrocautery Hot Forceps in Swine

Abstract

Background: Transbronchial lung biopsy (TBLB) is a commonly performed bronchoscopic procedure. Previous studies have suggested that larger biopsy forceps may improve diagnostic yield; however, the risk of bleeding associated with larger samples may be increased. The hot forceps are large forceps that are connected to an electrocautery system to minimize bleeding at the time of biopsy. Objectives: We evaluated the hot forceps for improvement in biopsy size and the number of sampled alveoli. Methods: TBLBs were performed in 2 swine using one type of the forceps, followed by the other forceps 24 h later. Electrocautery was applied from closure of the forceps to retrieval of the sample. A blinded pathologist measured the size of each sample in its longest dimension and calculated the total alveolar content within the largest cross-section from each biopsy. Results: A total of 74 biopsies were collected using each forceps type. Alveolar tissue was present in 25/74 and 26/74 of the biopsies using the hot and conventional forceps, respectively. There was no difference in the size of biopsies collected (2.10 ± 1.10 vs. 1.83 ± 0.94 mm; p = 0.164) or in the amount of alveoli per sample (343.2 ± 402.4 vs. 439.5 ± 463.5 alveoli; p = 0.433) for hot and conventional forceps, respectively. There was no artifact related to the use of electrocautery, and bleeding was minimal using either forceps system. Conclusions: The use of the electrocautery hot forceps for TBLB did not result in improvement of the size of biopsies or the amount of collected alveolar tissue in healthy pigs.

Simultaneous Multi-Antibody Staining in Non-Small Cell Lung Cancer Strengthens Diagnostic Accuracy Especially in Small Tissue Samples

“…This approach can be considered similar to endobronchial sampling as 1) endobronchial biopsies are not guided by histomorphology and, thus, are also taken from a histomorphologically random tumor area and 2) tissue specimens gathered by current endobronchial techniques deliver comparable sample sizes [37]. It can therefore be assumed that simulation of bronchial biopsies by the use of TMAs with an adequate core diameter delivers equal results and is comparable to the clinical-histopathological setting.…”

Transbronchial lung biopsy: the pathologist's point of view

“…Obtaining adequate tissue specimens for pathologic diagnosis when the patients do not undergo surgery is an important step in the diagnostic work up of pulmonary diseases. Transbronchial lung biopsy (TBLB) via flexible bronchoscopy is commonly used to diagnose a wide range of pulmonary diseases (1). However, this technique has some limitations, the most important of which is the small size of obtained specimens.…”

“…However, this technique has some limitations, the most important of which is the small size of obtained specimens. Furthermore, the biopsy specimens are often subjected to punch and crush artifacts (1)(2)(3)(4). Another limitation of this method is the lack of bronchial and acinar structures for assessment.…”

“…In recent years, several methods such as the use of hot forceps have been suggested in order to obtain larger biopsy specimens. However, studies have failed to find a significant difference in the size of the obtained specimens, or the number of alveolar spaces in the specimens obtained by these methods vs those obtained by conventional forceps (1). Cryoprobe has been used in bronchoscopy since 1976 (2).…”

A Randomized Controlled Trial of Electrocoagulation-Enabled Biopsy versus Conventional Biopsy in Diagnosis of Endobronchial Lesions

“…One animal study and one clinical study did suggest that EC+ biopsy does not alter specimen results [2,3] . Hence, no patient missed any chance of a gold standard.…”