Methods of biopsy during bronchoscopy

Methods of biopsy during bronchoscopy

An important part of diagnostic bronchoscopy is biopsy. It is performed to establish the diagnosis and determine the prevalence of the bronchial process.

During bronchoscopy, the collection of material for cytological and histological studies is performed in several ways, each of which has its own indications.

The material for bacteriological and cytological (for atypical cells and mycobacterium tuberculosis) studies is taken using a catheter conducted through a biopsy channel of the endoscope into a sterile tube or glass vial. If the contents of the bronchi are scant, first install 20 ml of isotonic sodium chloride solution, and then aspirate the solution mixed with bronchial content.

Direct biopsy. This is the most common method of obtaining tissue for cytological and histological studies. The biopsy, performed with the aid of both forceps and brush-scriber (brush-biopsy), refers to the straight line.

The following contraindications to the biopsy:

• hemophilia;
• tumors of the trachea and bronchi, if they are a source of active bleeding.

After examination of the pathological formation, biopsy forceps are inserted through the endoscope channel and under visual control bring them closer to the biopsy site, perpendicular to the formation from which the material is taken. The tongs open, rest against the formation, from which a biopsy is taken, then the brans are closed and the forceps are pulled out together with the cut piece. The obtained biopsy fragments have a size of 0.1-0.2 cm. They are made with fingerprints for cytological examination, and the biopsy fragment is immersed in a vial with a 10% formalin solution.

Biopsy scraping (brush-biopsy). This method was first used by Hattori in 1964. The most convenient object for a brush biopsy is small bronchi, when the brush fills the entire lumen and scrapes the mucosa along the entire circumference. Under the eyesight control, the scarifier brush is brought to the pathological site, pressed against it and several scraping movements are made on its surface. After that, it is approached to the distal opening of the biopsy channel and removed together with the bronchoscope. Make a few smears-prints, then wash the brush, remove and process the bronchoscope.

Catheter biopsy. The founder of this method is Friedel, who in 1953 at an international congress in Berlin reported on the results of 9 1 2 catheter biopsies. The term "catheter biopsy" also belongs to him. This method is used to verify the diagnosis of peripheral tumors. It is carried out as follows. Under the control of the bronchophobroscope, the catheter is inserted into the mouth of the corresponding segmental bronchus, then under radiographic control it is immersed in a pathological focus. A syringe or suction in the catheter creates a vacuum and aspirates the contents of the pathological focus. The catheter is then removed and its contents blown onto slides.

Aimed biopsy and brush-biopsy of peripheral formations under X-ray control. Preliminary, based on the study of chest radiographs, localization of pathological formation in the lung is determined. Under the control of vision in the mouth of the corresponding subsegmental bronchus, biopsy forceps are injected. Under X-ray television control, forceps are placed in the peripheral parts of the bronchial tree and set against a background of shading in the lung. Branchi forceps open on inhalation and close on exhalation, grabbing a piece of tissue. A reliable indication that the forceps are at the target is the shift of the shadow when trying to further hold the opened forceps and their correct position in the straight and lateral projections. With the X-ray inspection, the traction of the closed forceps displaces the shadow of the pathological formation in the proximal direction. To verify the diagnosis, at least 2 to 3 pieces of tissue are required.

Transbronchial lung biopsy. This method was first performed by Andersen et al. In 1965. Its use is shown for the diagnosis of peripheral infiltrates and diffuse lesions of lung tissue. Contraindications are polycystic pulmonary disease and severe emphysema. Do not perform bi-biopsy and a biopsy in the middle lobe and tongue, where you can easily perforate the interlobular pleura.

Under the control of vision, biopsy forceps are carried out in the bronchi of the most affected segment until the patient feels a small injection. This indicates that the forceps are at the pleura. The position of the forceps is controlled by an electron-optical attachment (EOP). The forceps are extracted approximately 1 cm. After confirming the correct position of the forceps, they are opened, then at the time of exhalation they slightly push forward and close, making a trial traction. If the patient complains of pain, this means that the visceral pleura is trapped by forceps. In this case, the forceps are extracted by 1 cm, open and repeat the entire study, or take a biopsy through another bronchus. Tightening of the lung tissue and separation of the parenchyma control the image tube.

Trans-tracheal, transbronchial puncture (aspiration) biopsy. The method was first developed in 1953 by Brouet et al. One of the first in this country to study this technique in an experiment and clinic studied Yu.L. Elyashevich (1962). Indications for aspiration biopsy are mediastinal tumors of an unknown origin, localized in the immediate vicinity of the bronchi, as well as all diseases accompanied by an increase in the lymph nodes of the mediastinum.

Under the control of vision, the needle is passed through the biopsy channel to the site of the puncture. Aspiration of the material is performed by creating a vacuum in a syringe and needle, which is immersed 0.5-1 cm into the wall of the bronchus. Continuing to create a vacuum in the syringe, the needle is slowly extracted and blown into the slide. The puncture is repeated several times.

[1], [2], [3], [4], [5]