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Quality, size and composition of paediatric endobronchial biopsies in cystic fibrosis

¹Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom ²Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, 1B Manresa Road, London SW3 6LR, United Kingdom ³Department of Lung Pathology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom ⁴Department of Anaesthesiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom

N.Regamey{at}imperial.ac.uk

Abstract

BackgroundStudies on airway remodeling in children with cystic fibrosis (CF) may be hampered by difficulty in obtaining evaluable endobronchial biopsies because of large amounts of mucus and inflammation in the CF airway. We prospectively assessed how quality of biopsies obtained from children with CF compare with those from children with other airway diseases.

MethodsFibreoptic bronchoscopy with endobronchial biopsy was performed in 67 CF children (age 0.2-16.8 years), 34 children with wheeze/asthma and 64 control children with chronic respiratory symptoms. Up to 3 biopsies were taken and stained with haematoxylin and eosin. Biopsy size and structural composition were quantified using stereology.

ResultsAt least one evaluable biopsy was obtained in 72% of CF children, in 79% of children with wheeze/asthma and in 72% of controls (NS). Use of large (2.0 mm) rather than small (1.0 mm) biopsy forceps (OR 5.8, CI 1.1-29.8, p=0.037) and number of biopsies taken (OR 2.6, CI 1.3-5.2, p=0.006) significantly contributed to success rate. Biopsy size and composition were similar between groups, except that CF children and those with wheeze/asthma had higher percentage of the biopsy comprised of muscle than controls (median 6.2% and 9.7% vs. 0.9%, respectively; p=0.002).

ConclusionsBiopsy size and quality are adequate for the study of airway remodeling in CF children as young as two months of age. Researchers should use large forceps when possible and take at least two biopsies per patient. Increased airway smooth muscle content of the airway mucosa may contribute to the pathophysiology of CF lung disease.

Key Words: cystic fibrosis • child • biopsy • airway smooth muscle • airway remodeling

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Endobronchial Biopsy in Childhood

Andrew A. Colin and Tarig Ali-Dinar
Chest 2007 131: 1626-1627. [Full Text] [PDF]

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				N. Regamey, T. N. Hilliard, S. Saglani, J. Zhu, I. M. Balfour-Lynn, M. Rosenthal, P. K. Jeffery, E. W. F. W. Alton, A. Bush, J. C. Davies, et al. Endobronchial Biopsy in Childhood Chest, January 1, 2008; 133(1): 312 - 313. [Full Text] [PDF]