Transbronchial lung biopsy

INTRODUCTION Transbronchial lung biopsy (TBB) is a safe and effective tool useful for the diagnosis of a wide variety of diffuse and focal pulmonary diseases. TBB is regularly performed by 69% of practicing physicians documented in a survey of 1,800 North American pulmonary and critical care physicians [1]. The procedure was first introduced by Andersen in 1965 for use via a rigid bronchoscope, and became more widely performed after it was adapted for use with the flexible bronchoscope in the early 1970s. This chapter describes the primary indications and contraindications to performing TBB during bronchoscopy, our approach to TBB, and methods to manage complications that may arise during or after the procedure. INDICATIONS Biopsy forceps commonly used for TBB via the flexible bronchoscope are generally of the order of 3 mm or smaller in any given dimension. Because of this restriction in size, tissue samples obtained via the transbronchial approach are generally 2–3 mm in any dimension. Despite the small size, TBB provides information regarding pathology that is located beyond the cartilaginous airways that may include elements of the small airways of the distal bronchial tree, the alveolar space, the vasculature, and lymphatic structures immediately surrounding the alveoli [2]. Pulmonary diseases that require examination of larger pieces of lung tissue to assess heterogeneity or homogeneity of different regions of the involved lung (such as many of the idiopathic interstitial lung diseases) are generally not amenable to diagnosis by TBB, so consideration of video-assisted thoracoscopic lung biopsy should be pursued for patients in whom these diseases are a strong consideration.