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

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Respiration (Impact Factor: 2.92). 09/2009; 79(2):137-40. DOI: 10.1159/000235818
Source: PubMed

ABSTRACT 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.
We evaluated the hot forceps for improvement in biopsy size and the number of sampled alveoli.
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.
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.
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.

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    ABSTRACT: IntroductionTraditionally cold biopsy forceps were used for endobronchial biopsy, and recently electrocautery (hot) bronchoscopy biopsy forceps are introduced. It is hypothesized that hot biopsy forceps may decrease procedure related bleeding and also may decrease the quality of obtained samples.
    Archivos de Bronconeumología 11/2011; 47(11):547-551. DOI:10.1016/j.arbres.2011.08.002 · 1.82 Impact Factor
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    Dataset: TBLB
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    ABSTRACT: Objectives The efficacy of flexible cryoprobe in providing high quality tissue specimens through bronchoscopy for making a diagnosis remains debatable. In this study, we have compared the diagnostic yield of cryoprobe with conventional sampling by forceps.Study selectionForty-one patients scheduled to undergo transbronchial lung biopsy (TBLB) in a pulmonary hospital in Tehran, Iran. Each patient underwent conventional TBLB and flexible cryoprobe transbronchial lung biopsy (FCLB) sequentially. Specimen adequacy was defined by the presence of at least 50 alveolar spaces or a positive diagnostic yield. Adequacy of specimens, number and percentage of alveolar spaces without artifact, type of artifact, presence of bronchiolar structures, and the diagnosis made based on the results of the two methods separately were compared.ResultsThe mean values of tissue section area obtained by forceps and cryoprobe were 6 mm2 (SD ±6.7) and 22 mm2 (SD ±19.1), respectively (P<0.001). Specimens were adequate in 26 cases of conventional TBLB and 40 cases of FCLB (P<0.001). Of adequate specimens, 14 samples obtained by TBLB and 28 samples obtained via FCLB were diagnostic. A significant difference was also detected between diagnostic and non-diagnostic specimens (P=0.04). Frequency of specimens with > 75% artifact-free lung parenchyma was significantly higher in FCLB method.Conclusion Flexible cryoprobe transbronchial lung biopsy method provides larger tissue samples with better quality compared to TBLB. Higher quality specimens are associated with less artifact and higher diagnostic yield. Multisite randomized trials are required to improve our knowledge about the benefits and indications of TBLB with cryoprobe.
    The Clinical Respiratory Journal 09/2014; DOI:10.1111/crj.12207 · 2.20 Impact Factor

Momen M Wahidi