The Effect of Forceps Size on the Adequacy of Specimens Obtained by Transbronchial Biopsy

Abstract

This study prospectively compared the diagnostic yield of transbronchial biopsies using large and small forceps (cup sizes, 3 x 2 x 0.9 versus 2 x 1.5 x 0.6 mm, respectively). Diagnostic yield was compared by a pathologist, blinded to the size of forceps used on the basis of the relative amount of tissue obtained, alveolar tissue obtained, and ability to ascertain a histopathologic diagnosis. Large forceps obtained significantly more tissue than did small forceps (20 of 27 patients [74%] versus five of 27 patients [19%], p < 0.005, with similar amounts obtained in two patients). Also, large forceps obtained significantly more alveolar tissue than did small forceps (16 of 22 patients [73%] versus six of 22 patients [27%], p < 0.05, with no alveolar tissue obtained in five patients). In 18 of the 27 patients, biopsies performed resulted in nonspecific diagnoses, including fibrosis or chronic inflammation. All nine of the patients with a specific diagnosis were ultimately proved to have sarcoidosis. There was a trend toward more of these patients having noncaseating granulomas obtained with the large forceps than with the small forceps (seven of nine patients versus four of nine patients). No difference was observed in the amount of postbiopsy bleeding with either forceps. We conclude that large forceps used for transbronchial biopsy yield more tissue and more alveolar tissue than do small forceps. These findings may have an impact on the diagnostic yield in some diseases such as sarcoidosis.

Diagnostic Invasive Procedures in Diffuse Infiltrative Lung Diseases

“…Specimens that floated were no more likely to be diagnostic or abnormal than specimens that sank (p < 0.05). Loube et al [59]prospectively compared the diagnostic yield of transbronchial biopsies using large and small forceps (cup sizes, 3 × 2 × 0.9 vs. 2 × 1.5 × 0.6 mm, respectively). Large forceps obtained significantly more tissue than did small forceps [20 of 27 patients (74%) vs. 5 of 27 patients (19%), p < 0.005].…”

Role of Flexible-Bronchoscopy in Pulmonary and Critical Care Practice

“…(Prakash at al., 1991;American Thoracic Society [ATS], 1987) A comparison of the yield of transbronchial biopsy specimen between standard-sized forceps and large forceps found no significant differences in the size of the biopsies or in the amount of alveolar tissue collected. (Wang et al, 1980;Loube et al, 1993) The tissue samples obtained by means of TBBx forceps are small, approximately 3 mm in size. Therefore, this procedure is not useful in diagnosing heterogeneous lung diseases such as idiopathic lung diseases.…”

“…(Papin et al, 1985;Zavala, 1976;Borchers & Beamis 1996) The risk of bleeding during TBBx seems to be unrelated to the size of forceps and is slightly higher in those being mechanically ventilated. (Loube et al, 1993;O'Brien et al, 1997) In patients with a potential increased risk of bleeding, coagulation profile should be checked before bronchoscopy. There is no information about what constitutes a "safe" level for clotting in this context.…”

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

“…However, one of the limiting features of this technique is the small sample obtained using conventional forceps [1]. Previous studies have suggested that larger forceps may improve diagnostic yield; however, as forceps become larger, there is greater concern about the development of complications, particularly bleeding [2,3,4]. In recent years, larger forceps connected to an electrocautery system, named the ‘hot forceps’, were designed for use with flexible bronchoscopy.…”