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Specimen of lung tissue (transbronchial biopsy) may be sampled using a real-time X-ray (fluoroscopy) or an electromagnetic tracking system. [12] Flexible bronchoscopy can also be performed on intubated patients, such as patients in intensive care. In this case, the instrument is inserted through an adapter connected to the tracheal tube.
A lung biopsy is an interventional procedure performed to diagnose lung pathology by obtaining a small piece of lung which is examined under a microscope. [ 1 ] [ 2 ] Beyond microscopic examination for cellular morphology and architecture, special stains and cultures can be performed on the tissue obtained.
The major criterion for diagnosis is typically a confirmed surgical biopsy.Minor diagnostic criteria have been proposed for DIPNECH. [8]Clinical presentation: woman, between the age of 45 and 67 with cough and/or shortness of breath for 5–10 years
Diagnostic specimens are often obtained via bronchoscopic transbronchial biopsy, CT-guided percutaneous biopsy, or video-assisted thoracic surgery (VATS). The diagnosis of inflammatory or fibrotic diseases of the lungs is considered by many pathologists to be particularly challenging.
In patients incapable of producing a sputum sample, common alternative sample sources for diagnosing pulmonary tuberculosis include gastric washings, laryngeal swab, bronchoscopy (with bronchoalveolar lavage, bronchial washings, and/or transbronchial biopsy), and fine needle aspiration (transtracheal or transbronchial).
Video-assisted thoracoscopic lung biopsy is the most definitive technique, but transbronchial biopsy has a yield of over 50% and can also be effective. [82] [83] The safety of the latter procedure in patients with diffuse cystic disease and the profusion of cystic change that predicts an informative biopsy are incompletely understood, however ...
A bronchoscopic transbronchial cryobiopsy, in which a camera is introduced into the airways followed by rapid freezing of an area of lung tissue prior to biopsy is associated a lower complication rate and a much lower mortality rate compared to VATS or surgical biopsy with near comparable diagnostic accuracy. [15]
Small biopsies, such as those obtained via transbronchial lung biopsy (performed during bronchoscopy) are usually not sufficient for this purpose. Hence, larger biopsies obtained surgically via a thoracotomy or thoracoscopy are usually necessary.