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document
The value of transbronchial lung biopsy using jumbo forceps via rigid bronchoscope in diffuse lung disease . BACKGROUND Transbronchial lung biopsy ( TBLB ) is a valuable procedure used to obtain a parenchymal specimen in the evaluation of diffuse lung infiltrates . Large forceps are expected to result in larger specimens and improve diagnostic yield . AIM The objective of this study was to evaluate diagnostic yield of TBLB using large modified flexible gastroenterological forceps ( " Jumbo forceps " ) compared with 'normal ' flexible forceps via rigid bronchoscopy in patients with diffuse parenchymal lung disease ( DPLD ) . METHODS The study was a prospective analysis of 95 patients who underwent fluoroscopy guided TBLB over a two year period . Patients with a lung mass or solitary lung nodule undergoing TBLB were excluded . The larger and small forceps were used in a random sequence to avoid a reduction in diagnostic yield of the second series of biopsies related to possible bleeding by first series of biopsies . To minimize the consequence of haemorrhage , we performed every rigid bronchoscopy , placing a non inflated Fogarty balloon and a rigid aspirator ( diameter 4 mm ) in lobar bronchus near the biopsy segment . The Fogarty balloon has been inflated in case of bleeding . After the bleeding was controlled we continued to operate up to the biopsy segment . RESULTS Diagnostic yield of TBLB using Jumbo forceps was significantly higher than using normal flexible forceps via rigid bronchoscopy in patients with DPLD ( p = 0.001 ) . In 74 out of 95 patients ( 78 % ) the diagnosis was placed with Jumbo forcep while the smaller forcep was diagnostic in 62 out of 95 patients ( 65 % ) . Large forceps obtained significantly more tissue than the small forceps ; the biopsy specimen taken with normal forcep measured in average 1.4 x 1.0 mm and the larger biopsy taken with jumbo forcep measured in average 2.5 x 1.9 mm ( p < 0.005 ) . CONCLUSION The use of large biopsy forceps to perform TBLB via rigid bronchoscope can significantly increase diagnostic yield in the pathological diagnosis of diffuse infiltrative lung disease .
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Intervention_Physical
underwent fluoroscopy guided TBLB over a two year period .
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Intervention_Physical
larger and small forceps
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Intervention_Surgical
bronchoscopy
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Intervention_Surgical
placing a non inflated Fogarty balloon
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Intervention_Surgical
rigid aspirator
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Intervention_Surgical
The Fogarty balloon has been inflated in case of bleeding
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Outcome_Physical
value of transbronchial lung biopsy
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Outcome_Physical
parenchymal specimen
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Outcome_Other
Diagnostic yield
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Outcome_Physical
tissue
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Participant_Condition
diffuse lung disease
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Participant_Condition
diffuse parenchymal lung disease ( DPLD
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Participant_Sample-size
95
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Participant_Condition
lung mass
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Participant_Condition
lung nodule
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Participant_Condition
DPLD
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Participant_Sample-size
74
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Participant_Sample-size
95
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Participant_Sample-size
78 %
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Participant_Sample-size
62
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Participant_Sample-size
95
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Participant_Sample-size
65 %
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Participant_Condition
diffuse infiltrative lung disease