Biopsy techniques during bronchoscopy

Methods of biopsy during bronchoscopy

An important component of diagnostic bronchoscopy is biopsy. It is performed to establish a diagnosis and determine the extent of the process in the bronchus.

During bronchoscopy, material for cytological and histological examination is collected in several ways, each of which has its own indications.

Material for bacteriological and cytological (for atypical cells and tuberculosis mycobacteria) studies is taken using a catheter inserted through the biopsy channel of the endoscope, into a sterile test tube or glass bottle. If the bronchial contents are scanty, then 20 ml of isotonic sodium chloride solution is first instilled, and then the solution mixed with the bronchial contents is aspirated.

Direct biopsy.This is the most common method of obtaining tissue for cytological and histological examination. Direct biopsy includes biopsy performed with both forceps and a brush-scarifier (brush biopsy).

There are the following contraindications to performing a biopsy:

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

After examining the pathological formation, biopsy forceps are inserted through the endoscope channel and brought closer to the biopsy site under visual control, positioning them perpendicular to the formation from which the material is taken. The forceps are opened, rested against the formation from which the biopsy is taken, then the branches are closed and the forceps are removed together with the excised piece. The resulting biopsy fragments are 0.1-0.2 cm in size. They are used to make smears-imprints for cytological examination, and the biopsy fragment is immersed in a vial with a 10% formalin solution.

Scraping biopsy (brush biopsy).This method was first used by Hattori in 1964. The most convenient object for brush biopsy is small bronchi, when the brush fills the entire lumen and scrapes the mucous membrane along the entire circumference. Under visual control, the scarifier brush is brought to the pathological area, pressed against it and several scraping movements are made along its surface. After that, it is brought closer to the distal opening of the biopsy channel and removed together with the bronchoscope. Several smears-imprints are made, then the brush is washed, removed and the bronchoscope is processed.

Catheter biopsy. Friedel is considered the founder of this method, who reported on the results of 9 1 2 catheter biopsies at the international congress in Berlin in 1953. 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 a bronchofibroscope, a catheter is inserted into the mouth of the corresponding segmental bronchus, then under X-ray control it is immersed in the pathological focus. Using a syringe or suction, a vacuum is created in the catheter and the contents are aspirated from the pathological focus. Then the catheter is removed and its contents are blown onto slides.

Targeted biopsy and brush biopsy of peripheral formations under radiological control.Preliminary, based on the study of chest X-rays, the localization of the pathological formation in the lung is determined. Under visual control, biopsy forceps are inserted into the mouth of the corresponding subsegmental bronchus. Under X-ray television control, the forceps are passed into the peripheral sections of the bronchial tree and placed against the background of shadowing in the lung. The branches of the forceps are opened on inhalation and closed on exhalation, grasping a piece of tissue. A reliable sign that the forceps are at the target is the displacement of the shadow when attempting to further pass the open forceps and their correct position in the direct and lateral projections. Under X-ray control, the traction of the closed forceps shifts the shadow of the pathological formation in the proximal direction. At least 2-3 pieces of tissue are required to verify the diagnosis.

Transbronchial lung biopsy.This method was first performed by Andersen et al. in 1965. Its use is indicated for the diagnosis of peripheral infiltrates and diffuse lesions of the lung tissue. Contraindications are polycystic lung disease and severe emphysema. Bilateral biopsy and biopsy in the area of the middle lobe and uvula, where the interlobar pleura can be easily perforated, should not be performed.

Under visual control, the biopsy forceps are inserted into the bronchus of the most affected segment until the patient feels a small prick. This indicates that the forceps are near the pleura. The position of the forceps is controlled by an electron-optical attachment (EOP). The forceps are withdrawn by approximately 1 cm. Having made sure that the forceps are in the correct position, they are opened, then slightly moved forward during exhalation and closed, performing a test traction. If the patient complains of pain, this means that the forceps have captured the visceral pleura. In this case, the forceps are withdrawn by 1 cm, opened and the entire examination is repeated, or a biopsy is taken through another bronchus. The EOP controls the pulling of the lung tissue and the tearing of the parenchyma.

Transtracheal, transbronchial puncture (aspiration) biopsy. The method was first developed in 1953 by Brouet et al. One of the first in our country to study this method experimentally and clinically was Yu. L. Elyashevich (1962). Indications for aspiration biopsy are mediastinal tumors of unclear genesis, localized in close proximity to the bronchi, as well as all diseases accompanied by an increase in the lymph nodes of the mediastinum.

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

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