The term “conventional biopsy techniques” implies all those traditional sampling techniques that can be used without adopting the latest technology. Even if the diagnostic possibilities and sensitivity of bronchoscopy have greatly increased by the recent advent of new technological tools, the use of conventional biopsy techniques remains relevantly unchanged and allows the pulmonologist to successfully approach a high percentage of endobronchial, pulmonary and mediastinal lesions for diagnostic purposes.
In this chapter, conventional biopsy techniques will be divided on the basis of the location of the lesion, analysing methods used for sampling central endobronchial lesions (i.e. lesions located within the visible range of flexible bronchoscope), peripheral pulmonary lesions or lung parenchyma and the pathological processes of the hilar-mediastinal area.
Conventional bronchoscopic sampling instruments used for lesions of the central airways, for peripheral pulmonary lesions and for pathological processes of the hilar-mediastinal area
Central endobronchial lesions
– Forceps biopsy
– Bronchial washing
– Transbronchial needle aspiration
Peripheral pulmonary lesions
– Forceps biopsy
– Bronchoalveolar lavage
– Transbronchial needle aspiration
– Cytology transbronchial needle aspiration
– Histology transbronchial needle aspiration
Indications, technique, possibilities and limits of each sampling method (forceps biopsy, brushing, bronchial washing, transbronchial needle aspiration) and of its association are reported.
Whenever a biopsy technique is employed, its use must always be guided by a global clinical assessment of the patient, evaluating the risk/advantage ratio and the benefits that can be obtained by the procedure case by case.
Only by integrating clinical, imaging and bronchoscopic techniques will it be possible to optimise bronchoscopy, thereby obtaining the best diagnostic accuracy, minimising the costs involved and having the lowest incidence of risks.
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