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: 2.59).
09/2009; 79(2):137-40. DOI: 10.1159/000235818
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.
Available from: Gian Kayser
- "To simulate the clinical approach of bioptically collected tissue samples, we used TMAs with a core diameter of 2 mm randomly taken from tumor paraffin blocks. 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 . 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. "
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ABSTRACT: Histological subclassification of non-small cell lung cancer (NSCLC) has growing therapeutic impact. In advanced cancer stages tissue specimens are usually bioptically collected. These small samples are of extraordinary value since molecular analyses are gaining importance for targeted therapies. We therefore studied the feasibility, diagnostic accuracy, economic and prognostic effects of a tissue sparing simultaneous multi-antibody assay for subclassification of NSCLC. Of 265 NSCLC patients tissue multi arrays (TMA) were constructed to simulate biopsy samples. TMAs were stained by a simultaneous bi-color multi-antibody assay consisting of TTF1, Vimentin, p63 and neuroendocrine markers (CD56, chromogranin A, synaptophysin). Classification was based mainly on the current proposal of the IASLC with a hierarchical decision tree for subclassification into adenocarcinoma (LAC), squamous cell carcinoma (SCC), large cell neuroendocrine carcinoma (LCNEC) and NSCLC not otherwise specified. Investigation of tumor heterogeneity showed an explicit lower variation for immunohistochemical analyses compared to conventional classification. Furthermore, survival analysis of our combined immunohistochemical classification revealed distinct separation of each entity's survival curve. This was statistically significant for therapeutically important subgroups (p = 0.045). As morphological and molecular cancer testing is emerging, our multi-antibody assay in combination with standardized classification delivers accurate and reliable separation of histomorphological diagnoses. Additionally, it permits clinically relevant subtyping of NSCLC including LCNEC. Our multi-antibody assay may therefore be of special value, especially in diagnosing small biopsies. It futher delivers substantial prognostic information with therapeutic consequences. Integration of immunohistochemical subtyping including investigation of neuroendocrine differentiation into standard histopathological classification of NSCLC must, therefore, be considered.
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