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Angled Forceps Used for Transbronchial Biopsy in Which Standard Forceps Are Difficult To Manipulate^*

A Comparative Study

^* From the Departments of Thoracic Malignancy (Drs. Sasada, Kobayashi, Hirashima, and Matsui) and Pathology (Dr. Kawahara), Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan; and the Department of Respiratory Medicine, Allergy and Rheumatic Diseases (Drs. Ogata and Kawase), Osaka University Graduate School of Medicine, Osaka, Japan.

Correspondence to: Shinji Sasada, Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, 3-7-1 Habikino, Habikino-Shi, Osaka 583-8588, Japan; e-mail: s-sasada{at}hbk.pref.osaka.jp

Abstract

Objectives: To evaluate the usefulness of the Sasada transbronchial angled forceps (STAF) in patients with peripheral pulmonary lesions (PPLs), which are difficult to manipulate with standard forceps.

Methods: We have invented the STAF, a forceps with an angled tip. One hundred ten patients with PPLs that were difficult to reach with standard forceps were retrospectively evaluated. The patients first underwent bronchoscopy with a standard forceps and then with the STAF. The specimens obtained with standard forceps and those obtained with STAF were separately fixed and analyzed histologically. We compared the histologic diagnosis of the specimens obtained by STAF with that obtained by the specimens obtained with standard forceps. Statistical significance was calculated with the McNemar ² statistic.

Results: The diagnostic yield of all lesions from the specimens obtained with STAF (86 of 110 lesions; 78.2%) was significantly higher than that of lesions from the specimens obtained with standard forceps (43 of 110 lesions; 39.1%; p < 0.001). Among malignant lesions, the yield obtained with STAF (60 of 72 lesions; 83.3%) was significantly higher than that obtained with standard forceps (32 of 72 lesions; 44.4%; p < 0.001). Among benign lesions, the yield obtained with STAF (26 of 38 lesions; 68.4%) was also significantly higher than that obtained with standard forceps (11 of 38 lesions; 28.9%; p < 0.001). Among the different lesion areas, the right upper lobe plus the left upper division gave the greatest difference in yield (STAF, 46 of 60 lesions; 76.7%; standard forceps, 22 of 60 lesions; 36.7%; p < 0.001). Among the different size ranges, the diagnostic yields obtained with STAF were significantly higher than that obtained with standard forceps except for the size range of 10 mm. There were two complications, pneumothorax and bronchial bleeding, both of which were controlled easily.

Conclusions: The STAF was shown to be useful for obtaining specimens that were sufficient for histologic diagnosis from PPLs that were difficult to manipulate with standard forceps.

Key Words: angled forceps • peripheral pulmonary lesions • transbronchial biopsy