Bushev, Jane and Buklioska Ilievska, Daniela and Jovevska, Svetlana and Baloski, Marjan and Poposki, Bozidar and Trajkovska, Vanche and Sajkovska, Iva (2024) Transbronchial biopsy. In: Drugi kongres bronhologa Srbije, 16-18 May 2024, Belgrade, Serbia.
Text
KONGRES-2024 (1).pdf - Published Version Download (2MB) |
|
Text
TRANSBRONHIJALNA BIOPSIJA.pdf - Published Version Download (5MB) |
|
Text
Kongres Bronhologa Beograd 2024 Transbronhijalna biopsija TBB-Poster (1).pdf - Presentation Download (1MB) |
|
Text
First Page Abstract Book.pdf - Published Version Download (782kB) |
Abstract
INTRODUCTION
Transbronchial biopsy (TBB or TBLB – transbronchial lung biopsy) is invasive method used to establish a definitive histological diagnosis in localized focal and diff use
changes in the lung parenchyma. TBB is performed under local anesthesia in hospital and outpatient patients. Sensitivity and specificity increase with the progression of X-ray changes and in the advanced stage of the disease. In some diseases (such as sarcoidosis), a characteristic histological picture can be obtained even when X-ray
changes cannot be observed. When performed under fluoroscopic control and with an experienced pathologist, the accuracy of transbronchial biopsy in the diagnosis
of localized malignant tumors is over 70%. Transbronchial lung biopsy (TBB), also known as “bronchoscopy lung biopsy” is a well-established technique and is commonly
performed by pulmonologists to obtain samples in focal and diff use lung disease. This technique has a low morbidity and mortality rate. Lung biopsy was performed by open
surgical methods until 1963, when Dr. Anderson performed a bronchoscopy lung biopsy using a rigid bronchoscope. Transbronchial lung biopsy (TBLB or TBB) via flexible
bronchoscopy (FB) was introduced in the early 1970s and has been widely used since then. There are many modifications of the transbronchial biopsy technique. It is most commonly performed by jamming the scope into the segmental bronchus of interest, then passing the forceps through the working channel of the scope and advancing to the diseased region until resistance is felt. Aft er that, the forceps are withdrawn about 1 - 2 cm, the jaws are opened and spread carefully, the forceps are advanced to the area where resistance is found, and the jaws are closed. Th e biopsy forceps must be pulled firmly to obtain the specimen. During the procedure, some doctors ask the patient about discomfort in the shoulders, chest or upper abdomen that would indicate the proximity of the pleural space, especially if fluoroscopy is not used. Closing the jaws of the forceps during expiration is also a common technique. Fluoroscopy is a type of X-ray imaging that provides a continuous image on a monitor. During fluoroscopy, an X-ray beam passes through the body and gives an image of the movement of a part
of the body or an instrument (can be seen in detail on the screen). Contraindications for TBB are respiratory weakness, mechanical ventilation, contralateral pneumectomy, suspicious vascular lesions, lung abscess, echinococcal cyst, pulmonary hypertension, bullous disease, persistent cough, coagulopathy, thrombocytopenia.
OBJECTIVE
The aim of the work is to determine the contribution and effectiveness of transbronchial biopsy in the diagnostic algorithm for localized and diff use X-ray changes in the lungs in hospitalized and ambulatory patients MATERIAL AND METHODS
in a retrospective analysis of a 20-year period (2003-2023), 450 bronchoscopy reports with performed TBB were considered (72 on an outpatient basis, in the other 378 TBB was performed in hospital conditions at the Pulmonology Department, exclusively rarely in patients hospitalized from other departments of the City General Hospital “8-mi September” in Skopje). In all of them, changes (focal or diff use) were observed on the radiograph of the lungs. Diagnostics included the following procedures: standard PA and profile radiography (in most cases, a CT scan of the chest with the use of intravenous contrast), fiberoptic bronchoscopy (mostly with an Olympus BF TYPE 1T 180 instruments, rarely with a Stortz fiberscope) and transbronchial biopsy with a flexible forceps.
RESULTS
according to the radiographic findings, we divided the respondents (N 395) into 4 categories Category 1 (N 268) – Unilateral localized changes according to the position and size of the X-ray changes, we identified two subgroups – central changes – peripheral changes (sizes under 30mm, 30-60mm and over 60mm) Category 2 (N 42) – Unilateral extended changes (tumor lesions and atelectasis) Category 3 (N 23) –
Mutual limited changes Category 4 (N 62) – Diff use changes in lung fi elds (interstitial changes) All subjects had a PERFECT endoscopic finding (within the physiological
range for a certain age: bronchi freely passing to the level of subsegments, carinae sharp, without submucosal or other pathological infiltrates). Th e male gender dominated
(67%), aged from 18 to 88 years. A total of 450 TBBs were performed in 395 patients (55 biopsies were repeated - 12%). A conclusive histopathological finding (histological
entity/diagnosis) was obtained in 270 (68%) patients in whom 306 biopsies were performed (68% of the total number, 36 were repeated biopsies). In the other 125
(32%) patients in whom 144 biopsies were performed (19 repeated), the obtained histological findings were categorized as “negative findings”. Conclusive (“positive”)
histopathological findings (from the first or from repeated TBB) are divided into 5 groups/categories • Non-Small Cell Lung Carcinoma (including the histopathological
entities Carcinoma planocellulare bronchogenes, large cell and Adenocarcinoma (including carcinoma bronchioloalveolar) as well as unclassified insufficiently defined
malignancy - 157 (58%) • Small Cell Lung Carcinoma (Carcinoma microcellulare bronchogenes (including the histopathology of Oat cell carcinoma and the finding of a
metastatic deposit) – 51 (19%) • Sarcoidosis 16 (6%) • Tuberculosis (including miliary form and the finding of insufficiently defined granulomatous tissue) - 19 (7%) • Other findings (such as “fibrosis”, “hemosiderosis” and histological descriptions that clinically fit into the categories of non-malignant entities but contributed to a large extent and significantly to the establishment (definition and formation) of the final diagnosis - 27
(10%) In 125 subjects from the first and repeated biopsies (144 in total), an inconclusive (“undefined”) histopathological finding was obtained (the pathologist’s answer was not sufficiently precise, clear or defined in the direction of malignancy, chronic inflammation and/or other benign changes, or the sample was small and unsuitable
for histological processing, which required a rebiopsy from a more representative site). Fluoroscopy was used in the performance of 404 biopsies (46 TBB were performed without fluoroscopic control, in 20 of which a “positive” histopathological finding was obtained). No major complications were observed. Partial pneumothorax was rarely
observed (in 13 – 3% of cases immediately or 24 hours aft er the first or repeated biopsy). It was usually a small self-limiting form that did not require major intervention (the
treatment was conservative, thoracic drainage was rarely used).
CONCLUSION
Th e results of this study indicate that biopsy during bronchoscopy examination is necessary in all radiographically unclear parenchymal lung infiltrates. TBB is a safe and inexpensive invasive diagnostic method for histological confirmation of lung changes. With a good selection of patients who have not been clarified, solid results are achieved with acceptable complications. Bronchial cancer treatment strategy requires a clear histopathological categorization. Accordingly, rebiopsy is indicated for insufficiently defined histological findings. Repeated biopsies increase the diagnostic contribution. The diagnostic contribution can be improved by fluoroscopy in selected patient populations with a reduced risk of complications. Fluoroscopically guided transbronchial biopsy is a time-effective, safe and effective method for focal and diffuse lung lesions.
KEYWORDS
Transbronchial biopsy, bronchoscopy, histopathological findings, fluoroscopy
Item Type: | Conference or Workshop Item (Poster) |
---|---|
Subjects: | Medical and Health Sciences > Clinical medicine |
Divisions: | Faculty of Medical Science |
Depositing User: | Daniela Buklioska Ilievska |
Date Deposited: | 11 Dec 2024 09:11 |
Last Modified: | 11 Dec 2024 09:11 |
URI: | https://eprints.ugd.edu.mk/id/eprint/35183 |
Actions (login required)
View Item |