Biopsia transbronquial. Asociación entre características morfológicas y diagnóstico histopatológico
Biopsia transbronquial. Asociación entre características morfológicas y diagnóstico histopatológico
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Objective: To evaluate the morphological characteristcs of transbronchial biopsies and to determine the association between these characteristics andthe possibility to obtain a specific diagnosis.
Design: Analytic observational study in a retrospective cohort.
Material and methods: This study was performed in the Hospital Santa Clara of Santa Fe de Bogotá, Colombia. We reviewed all the transbronchial biopsies performed in patients older than 15 years with parenchymal lung disease, focal or diffuse, from January 1978 to June 1997. The histopathological examination was carried out by an investigator who was blinded to previous diagnosis. The following morphological characteristics were analyzed: presence of alveolar tissue, number of obtained fragments per biopsy, total number of alveoli present in the biopsy and presence or not of collapse, bronchial wal1 and cartilage. The association between these morphological characteristcs and the possibility to obtain a specific diagnosis was evaluated using the SPSS statistic program.
Results: Six hundred thirty-three biopsies were anal yzed. Of them, 613 (97%) showed alveolar tissue (alveoli). A specific diagnosis was stablished in 347 (57%). The most frequent diagnosis were silicoanthracosis (27%), neoplasms (71 %), tuberculosis (7 0%}, diffuse alveolar hemorrhage (9%}, interstitial pneumonitis (6%}, lymphocytic alveolitis (5%} sarcoidosis (5%) and hypersensitivity pneumonitis (5%). The possibility to get a diagnosis increased when a major number of fragments was obtaíned wíth the bíopsy (p<0. 0001, Table Nº 2). Likewise, a diagnosis was easíest obtained when the number of alveoli in the sample wa$ higher than 60 and when collapse was absent (p<0.0001, Tables Nº 3 and 4). Presence of cartílage reduced this possíbílíty (p<0. 022, Table Nº 6).
Conclusions: To get a majar díagnostic perfomance using transbronchial biopsies it is advisable to obtain more than three fragments so big to contaín at least 60 alveoli, preferably in the perípheríc lung (without cartilage). lts manípulatíon must avoid the collapse.
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