Diagnostic Yield of Transbronchoscopic Biopsies

Abstract

Transbronchoscopic biopsies of lung (transbronchial) or bronchus (endobronchial) have a high diagnostic of yield when performed by a single expert bronchoscopist or a small group of expert bronchoscopists. This procedure's diagnostic yield was evaluated in a general hospital where biopsies are performed by a diverse group of individuals. One hundred fifty-one consecutive biopsies were reviewed, including 53 transbronchial biopsies and 98 endobronchial biopsies. Only 44% of endobronchial biopsies and 21% of transbronchial biopsies were diagnostic. The diagnostic yield was significantly greater in patients with suspected neoplasms (48%) than in patients with suspected infections (13%). Of 97 patients who ultimately had definitive diagnoses established, 43 (44%) had negative biopsy results, including 36% of those with cancers and 80% of those with infections. Failure to obtain alveolar parenchyma by transbronchial biopsy (probably related to the absence of fluoroscopic control) and failure to obtain multiple tissue fragments during each procedure contributed to the low diagnostic yield. The especially disappointing results of transbronchial biopsy for diagnosis of infection suggest that, in this hospital setting, open lung biopsy may be the procedure of choice when infection is suspected.

Possible recurrence of desquamative interstitial pneumonitis in a single lung transplant recipient

“…Therefore, there can be some doubt as to the diagnostic yield of transbronchial biopsies, especially for the diagnosis of chronic interstitial pneumonia. Even open lung biopsy is not always diagnostic [18][19][20][21]. TBB is, however, very sensitive for the diagnosis of acute rejection, with a diagnostic yield ranging 72-94% [22][23][24].…”

Comparison of processing techniques for detection of Pneumocystis carinii cysts in open-lung biopsy specimens

“…Bronchial washings are very infrequently positive, and the transthoracic needle biopsy has not been considered to be an optimal method (1). Transbronchoscopic biopsy ordinarily requires several specimens to ensure adequate sampling (4). Open-lung biopsy has been considered to be the most accurate specimen for the definitive diagnosis of Pneumocystis infection (10).…”

Use and Abuse of Lung Biopsy

“…Whereas this sample may be sufficient for the diagnosis of malignancy, where certain histopathological features are quite obvious even in small-sized samples, it may not be enough for certain non-neoplastic disorders. 48,59,60 For example, in the setting of lung transplantation, it has been suggested that at least five pieces of alveolated lung tissue containing more than 100 alveoli be present for a proper evaluation. 61 Another major problem with TBBx is the inability to evaluate the lowpower architectural features that are essential in making certain diagnosis, particularly for interstitial lung diseases.…”