Transbronchial and Endobronchial Biopsies

The reduced morbidity and mortality of bronchoscopic biopsies as compared with surgical lung biopsies makes them a powerful tool to the pulmonologist when dealing with either diffuse or localized lung diseases. As such, these are the most common specimens received in lung pathology. However, these small biopsies provide the pathologist with a limited sampling area that usually lacks histologic preservation because of mechanical crushing of the tissue, with consequent interpretation difficulties. Its clinical value, therefore, is determined by several factors, including the probability of successfully sampling the area of interest, but, very importantly, the likelihood that an appropriate diagnosis will be made by the practicing pathologist. For this reason, a book focusing on the histopathologic findings on transbronchial and endobronchial biopsies, considering the limitations and diagnostic algorithms when evaluating these tiny specimens, is a great aid. ‘‘Transbronchial and Endobronchial Biopsies’’ is an atlas-format book with over 280 pictures that illustrate 41 chapters in 162 pages. All the findings, from artifacts and nonspecific changes to specific pathologic processes that one can encounter when evaluating transbronchial and endobronchial biopsies are presented. The first 2 chapters contain an introductory overview of transbronchial and endobronchial biopsies. Chapter 1 discusses the advantages and limitations of transbronchial and endobronchial biopsies as well as the criteria for the decision to attempt a bronchoscopic biopsy. Owing to the nature of the biopsy procedure, artifacts are a constant finding in bronchoscopic biopsies, which might lead to misinterpretation as pathologic changes if not considered. These findings are included in the second chapter along with nonspecific normal changes, like endogenous structures, dystrophic calcification, etc, that are found in these biopsies not uncommonly. How the ‘‘unexpected’’ findings could be misinterpreted is illustrated in some of the pictures (an example of this being tissue compression, which not uncommonly leads to the wrong impression of interstitial fibrosis). Chapters 3 to 40 have been organized following a disease pattern. Neoplastic processes are discussed in Chapters 3 to 8, infections in Chapters 9 to 15, diffuse lung diseases in Chapters 16 to 34, transplantation pathology in Chapters 35 and 36, large airway pathology in Chapter 37, pediatric pathology (including an introductory discussion of the limited role of transbronchial and endobronchial biopsies in this patient population) in Chapters 38 and 39, and primary ciliary dyskinesia in Chapter 40. The last chapter was left for some words about medicolegal implications of transbronchial biopsies. The chapters focused on neoplastic diseases are an example of the practical approach of bronchoscopic biopsies presented in the book. As the great majority of the lung carcinomas, particularly non-small cell carcinomas, are histologically heterogeneous tumors, classifying these neoplasms in bronchoscopic biopsies might require a substantial effort. However, a definitive diagnosis or tumor type is not always crucial to render in every transbronchial or endobronchial biopsy. Indeed, the World Health Organization classification of lung neoplasms is based primarily on tumors examined in resection specimens. What are the important steps in the diagnostic process, how to improve the accuracy of tumor classification when compared with the resection specimen, and when it is important to classify and not in transbronchial or endobronchial biopsies, are concisely discussed. As its companion book, ‘‘Color Atlas and Text of Pulmonary Pathology’’ by Dr Cagle (editor-in-chief), and as appropriate for an atlas, the chapters in ‘‘Transbronchial and Endobronchial Biopsies’’ are concise and meant for rapid review, highlighting relevant information needed for the diagnostic considerations. In addition, ‘‘Suggested Readings’’ are provided at the end of each chapter, which include short lists of key articles and textbooks for the specific topics, helpful for those readers who want to seek more details on a particular topic. The pictures illustrate the text in a ‘‘real world’’ way, as the majority of the examples include a very low-power photograph of the biopsy pieces, which explains, despite the good quality, the lack of visual appeal in many of them. However, as prefaced by the authors, one of the aims of the book is to ‘‘honestly reflect the experience of the practicing pathologist’’ and that would have not been achieved without the inclusion of those photographs. The figure legends are clear, which, concurrently with the increasing magnification pictures, transmit the idea that the authors are showing the case under the microscope. Finally, instant access to the fully searchable text and downloadable images makes the book convenient at all times. In summary, ‘‘Transbronchial and Endobronchial Biopsies’’ covers the entire spectrum of neoplastic and non-neoplastic lesions of the lung in concise chapters focusing on the diagnostic clues and limitations on transbronchial and endobronchial biopsies. This book provides a practical guide for trainees and practicing general pathologists who encounter these small specimens in their daily signout.