Transbronchial lung biopsy

Transbronchial lung biopsy is a diagnostic method that allows you to confirm or refute the presence of diseases such as tuberculosis and lung cancer. The method involves taking a sample of lung tissue for further histological examination.

This type of diagnosis is prescribed if any pathological change in the lung is visualized. In other words, if there are shadows in the lungs on the x-ray, the doctor may assume the presence of an oncological formation or other pathology, and to confirm the diagnosis, he prescribes a transbronchial lung biopsy.

Types of lung biopsy

During the initial examination and consideration of the results of other diagnostics, the doctor determines the most optimal biopsy method. In clinical practice, the following types of puncture manipulations and biopsies of the respiratory system are used.

Transbronchial lung biopsy – samples of cells and tissues for histological examination are obtained by puncturing bronchial tissue. This procedure is brush, forceps and needle (forceps biopsy – the necessary tissues for research are obtained by pinching off the lung tissue).

Transthoracic lung biopsy is an endoscopic method that allows tissue to be collected using a trephine-like or aspiration needle, with which the chest is pierced to gain access to the lungs. An open lung biopsy is a thoracotomy. The procedure involves a complete opening of the chest and the collection of the necessary cells and tissues for further research.

Puncture of bifurcation lymph nodes – used to diagnose the lymph nodes of the trachea. Cells and tissues for diagnosis are taken using a special syringe. Diagnosis allows you to determine the presence of cancer and the process of metastasis.

Choosing a site for taking a biopsy sample

Before performing a transthoracic lung biopsy, it is necessary to study the X-ray or CT scan as carefully as possible in order to accurately determine the location of the biopsy. One of the simplest methods for determining the intended site is the following: all airways are considered as a clock face, and lymphatic formations or nodes are considered as time. In this case, it is important to understand that the CT examination is carried out in the direction from head to toe, and in bronchoscopy, the airways are examined in the direction from head to toe.

It is for this reason that if the neoplasm is placed on the CT scan results in accordance with 3 o’clock on the dial, therefore, during the procedure, all manipulations will be performed in accordance with 9 o’clock on the dial. To simplify, you can simply flip the CT results on the vertical axis. If the diagnostic procedure is performed by the oral route, there is no need to change or rotate the image. The procedure for planning a site for a biopsy is an important and crucial moment, on which the result directly depends.

Contraindications and getting results

Contraindications to the procedure are:

• intolerance to anesthetics;
• pregnancy;
• menstrual period;
• respiratory diseases in the acute phase;
• severe hypertension;
• aortic aneurysm;
• myocardial infarction;
• decompensated heart disease.

During the initial examination, the doctor prescribes a number of additional tests and studies in order to exclude the presence of contraindications. Subject to all the rules, you can avoid the development of complications such as: bleeding or hemoptysis; pulmonary edema; a sharp increase in temperature; pneumatic and bronchospastic complications.

After tissue and cell samples are taken, they are sent to the laboratory for histological examination. The results will be ready in ten to fourteen days, depending on the type of disease.

Preparing for the procedure and performing the procedure

Before the procedure, the possible complications and risks are explained to the patient without fail. The doctor also collects information about the presence of blood pathology, pregnancy, allergic reactions, etc. You need to prepare in advance for a lung biopsy, namely:

• refuse food at least six hours before the diagnosis;
• refuse to take warfarin, aspirin and other drugs that help thin the blood;
• remove lenses, dentures and all jewelry.

It is important to warn the doctor if there are any prostheses or implants in the body.

If the surgeon decided to diagnose using a bronchoscope, then it is inserted through the nose or mouth and a biopsy is performed. This method is most often prescribed for chronic cough with blood impurities in the sputum.

It is important during the period of tissue sampling to control the procedure in parallel with the help of an ultrasound study. An ultrasound examination is not needed if an open biopsy is performed.

Local anesthesia is used for transbronchial biopsy. Only for open or video-assisted thoracoscopic biopsy, general anesthesia is used. When using general anesthesia, the patient is connected to a ventilator.

In the presence of sarcoidosis (a connective tissue pathology in which nodules form on the surface of the lungs), a biopsy is the main and very significant diagnostic procedure. Based on the results of histology, the degree of malignancy of the neoplasms is determined as accurately as possible and an effective treatment is selected.

When lung cancer is suspected, bronchoscopy with bronchial needle biopsy is used (if central lung cancer is suspected) and percutaneous needle biopsy, controlled by computed tomography (if peripheral lung cancer is suspected).

Regardless of the chosen biopsy method, the procedure should be carried out by a highly qualified specialist, only in this case the development of complications can be avoided.

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