INDICATIONS:

Specimens from lungs are taken:

-For the diagnosis, treatment and palliation of neoplasms.

Pleural biopsy is usually taken:

-To help in the differential diagnosis of pleural effusions and pleural tumours.

Other reasons for lung biopsy include:

i) Assessment of inflammatory lesions such as sarcoidosis , tuberculosis and fungal infections.

ii) Fibrosing lung diseases and

iii) Rejection changes in heart / lung transplants.

iv) Rarely biopsies are taken in the investigation of asthma and its response to treatment.

A number of techniques are available to obtain pulmonary and pleural tissue for histological diagnosis.

For information on the approach to histopathological reporting and handling of specimens click on the following links:

- Percutaneous Needle and Trucut Biopsy Specimen:

- Bronchial Biopsy Specimen:

- Transbronchial Biopsy Specimen:

- Transbronchial biopsy in lung transplant recipients:

- Open lung biopsy:

- Lobectomy or pneumonectomy specimens for neoplasia and non  neoplastic diseases of the lung:

- Closed pleural biopsy for neoplasm or inflammatory lesions  ; open pleural biopsy and pneumonectomy or pleural stripping:

Histopathological reporting of pulmonary parenchymal biopsies: Useful chromatic and immuno-stains in pulmonary pathology

Along with the lung or pleural biopsy specimen following clinical information should be provided by the clinician to the histopathologist :

Lung Biopsy Specimen:

- Age and sex of the patient; 

- Clinical signs and symptoms and their duration.

- History of smoking;

- History of tuberculosis , systemic malignancy or other diseases (Cushing’s syndrome, diabetes insipidus, hypertrophic osteoarthropathy, rheumatoid arthritis & other connective tissue disease);

- Occupation

- History of previous instrumentation in the lung

- Results of other investigations :(radiological and microbiological ). 

Pleural biopsy specimen:

- Age and sex of the patient; 

- Clinical signs and symptoms and their duration.

- Clinical examination -  hilar  lymphadenopathy;

- Occupation (especially history of asbestos exposure);

- History of smoking;

- History of tuberculosis or systemic malignancy.

- History of hilar lymphadenopathy

- Results of other investigation:( radiological and microbiological).

INTRODUCTION: During the last 20 years routine application of various methods of multiple "small biopsies" of the lungs such as forceps, transbronchial, trucut percutaneous and so on, has significantly increased the efficacy of diagnostics of bronchopulmonary and pleural diseases. Tissue samples, not bigger than 3-4 mm, in which diagnostic pathological changes are expected on the basis of previous clinical, radiological and bronchoscopic examinations, can be the basis for making a definite therapeutical decision only if a skillful surgeon has performed the biopsy by correct instruments and from the right place and sent it for histological analysis with other important clinical information. This study is a comment on quality, significance and possibilities of improving clinical-pathological cooperation in this field of clinical pathology. MATERIAL AND METHODS: By correlation of clinical and histological diagnoses we analyzed the diagnostic efficiency of microscopic examinations of "small biopsies" of the respiratory tract in 319 patients (175 bronchial forceps biopsies, 31 transbronchial biopsies, 22 percutaneous needle pleural biopsies and 91 combined forceps and transbronchial biopsies) in whom biopsies were performed during 1996 in the Specialized Hospital for Lung Diseases Brezovik. RESULTS: Overall concordance between the clinical and histopathological diagnosis was 82.2%. In 99 cases (73.3%) out of 135 clinically "obvious" neoplasms, the histopathological examination confirmed existence of malignant tumor: squamous cell carcinoma in 80%, small cell carcinoma in 9.6% and adenocarcinoma in 5.6% of patients. In other patients it was not possible to perform a more precise classification. Endoscopic specimens of 29 patients (9.1%) were not representative. CONCLUSION: The level of diagnostic efficiency (73.3%) of definitive histopathological verification of bronchopulmonary lesions, which have been clinically diagnosed as malignancies, is rather high, but the increase of diagnostic efficiency requires application of more sophisticated histological diagnostic methods (immunohistochemical) and more frequent utilization of bioptic procedures which are more convenient for detection of peripheral pulmonary lesions (transbronchial and percutaneous fine needle aspiration biopsies of the lungs).

Bronchoscopic diagnosis and staging of lung cancer.Chest Surg Clin N Am. 2001 Nov;11(4):701-21, vii-viii

In the past 2 decades, flexible bronchoscopy (FB) with forceps biopsy and transbronchial needle aspiration (TBNA); computed tomography (CT)-guided, transthoracic fine-needle aspiration (FNA); and endoscopic ultrasonography (EUS) have revolutionized lung cancer diagnosis and staging by facilitating precise biopsy of lung lesions and virtually all mediastinal lymph-node stations. In this article the authors present an algorithm for the diagnosis and staging of lung cancer that addresses sampling of suspicious lesions and lymph nodes by means of FB, CT, ultrasonography, fluoroscopy, and EUS, emphasizing tissue-based diagnosis and staging by means of image-guided technology with the highest diagnostic yield. They discuss the approach to the diagnosis and staging of lung cancer by techniques guided by FB, with particular attention to the increasing role of TBNA in this field. Additionally, the authors propose a rating scale based on the degree of invasiveness and diagnostic yield, comparing FB with other diagnostic techniques.

Bronchoscopic needle aspiration biopsy.Am J Clin Pathol. 2000 May;113(5 Suppl 1):S97-108

Bronchoscopic needle aspiration biopsy, which encompasses transbronchial needle aspiration, transtracheal needle aspiration, and endobronchial needle aspiration, is a minimally invasive technique used to diagnose mediastinal and pulmonary masses and to stage lung cancer patients with mediastinal lymphadenopathy. Since it is safe, accurate, and potentially cost-efficient, its use may increase in the coming years. It is important that pathologists who examine cytology specimens understand this procedure, its limitations, and ways that it may be optimized.

Bronchoscopy in diffuse lung disease: evaluation by open lung biopsy in nondiagnostic transbronchial lung biopsy.Ann Otol Rhinol Laryngol. 1987 Nov-Dec;96(6):654-7

Transbronchial lung biopsy through the flexible bronchoscope is used widely for the diagnosis of diffuse lung disease; however, a significant number of specimens obtained by the bronchoscopic 2-mm biopsy forceps will reveal nonspecific findings, eg, interstitial fibrosis or nonspecific pneumonitis. Such a report may be an accurate reflection of the presence of idiopathic pulmonary fibrosis or nonspecific pneumonitis, but may merely indicate that the true diagnosis has been missed. We retrospectively studied 38 patients with diffuse lung disease whose transbronchial lung biopsies yielded nonspecific abnormalities. Subsequently, these patients were subjected to open lung biopsies. Nineteen of the 38 patients (50%) had a specific diagnosis made by open lung biopsy. The diagnoses included bronchiolitis obliterans, alveolar proteinosis, metastatic carcinoma, lymphoma, tuberculosis, and bronchioloalveolar cell carcinoma. Although transbronchial lung biopsy is useful in the diagnosis of many diffuse lung diseases, it is not a replacement for open lung biopsy. When nonspecific findings by transbronchial lung biopsy do not correlate with the clinical picture, open lung biopsy should be performed.

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