Background: Lung biopsies obtained during medical pleuroscopy using coagulating forceps could represent a cost-effective alternative to surgical lung biopsies in patients with diffuse parenchymal lung diseases (DPLD). However, it is not clear whether these patients should undergo deeplung biopsies rather than more superficial subpleural lung biopsies. Objectives: The aim of this experimental animal study was to compare gross and microscopic features of deep and subpleural pleuroscopic lung biopsy samples. Methods: Six male sheep (median weight 40 kg) underwent lung biopsies via pleuroscopy under general anesthesia. The following parameters were studied: weight, size, quality of the parenchyma and visceral pleura, parenchymal vessels and bronchial tissue. Results: The mean number of biopsies taken per animal was 4.5 ± 1.22 and 4.83 ± 1.33 (p = 0.36) for deep and subpleural biopsies, respectively. The mean size of deep and subpleural biopsies was 1.758 ± 0.478 and 1.283 ± 0.851 cm2, respectively (p = 0.0006). The mean weight of deep biopsies and subpleural biopsies was 0.156 ± 0.092 and 0.145 ± 0.047 mg, respectively (p = 0.83). No statistically significant difference was found between subpleural and deep biopsies regarding the mean quality scores of parenchyma-pleura (p = 0.36), vessels (p = 0.36), or bronchial tissue (p = 0.20). Conclusion: Both subpleural biopsies obtained during pleuroscopy and deep lung biopsy specimens obtained by electrocautery in animal subjects provided satisfactory material for histologic examination. Therefore, in DPLD, where the subpleural layers are involved, subpleural biopsies obtained during pleuroscopy might be sufficient for establishing an accurate diagnosis.

1.
Rodriguez-Panadero F: Medical thoracoscopy. Respiration 2008;76:363–372.
2.
Froudarakis ME: Diagnostic work-up of pleural effusions. Respiration 2008;75:4–13.
3.
Vansteenkiste J, Verbeken E, Thomeer M, Van Haecke P, Eeckhout AV, Demedts M: Medical thoracoscopic lung biopsy in interstitial lung disease: a prospective study of biopsy quality. Eur Respir J 1999;14:585–590.
4.
Dijkman JH, van der Meer JW, Bakker W, Wever AM, van der Broek PJ: Transpleural lung biopsy by the thoracoscopic route in patients with diffuse interstitial pulmonary disease. Chest 1982;82:76–83.
5.
Miller JD, Urschel JD, Cox G, Olak J, Young JE, Kay JM, et al: A randomized, controlled trial comparing thoracoscopy and limited thoracotomy for lung biopsy in interstitial lung disease. Ann Thorac Surg 2000;70:1647–1650.
6.
Allen MS, Deschamps C, Jones DM, Trastek VF, Pairolero PC: Video-assisted thoracic surgical procedures: the Mayo experience. Mayo Clin Proc 1996;71:351–359.
7.
American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus. Classification of the Idiopathic Interstitial Pneumonias Am J Respir Crit Care Med 2002;165:277–304.
8.
Utz P, Ryu JH, Douglas WW, Hartman TE, Tazelaar HD, Myers JL, Allen MS, Schroeder DR: High short-term mortality following lung biopsy for usual interstitial pneumonia. Eur Respir J 2001;17:175–179.
9.
Maldonado F, Ryu JH: Surgical biopsy for diffuse parenchymal lung diseases: are we causing more harm than good? J Bronchol Intervent Pulmonol 2009;16:227–228.
10.
Kreider ME, Hansen-Flaschen J, Ahmad NN, Rossman MD, Kaiser LR, Kucharczuk JC, et al: Complications of video-assisted thoracoscopic lung biopsy in patients with interstitial lung disease. Ann Thorac Surg 2007;83:1140–1144.
11.
Qureshi RA, Ahmed TA, Grayson AD, Soorae AS, Drakeley MJ, Page RD: Does lung biopsy help patients with interstitial lung disease? Eur J Cardiothorac Surg 2002;21:621–626; discussion 626.
12.
Van Schil P: Cost analysis of video-assisted thoracic surgery versus thoracotomy: critical review. Eur Respir J 2003;22:735–738.
13.
England GC, Clarke KW: The use of medetomidine/fentanyl combinations in dogs. Acta Vet Scand Suppl 1989;85:179–186.
14.
Robinson EP, Sams RA, Muir WW: Barbiturate anesthesia in greyhound and mixed-breed dogs: comparative cardiopulmonary effects, anesthetic effects, and recovery rates. Am J Vet Res 1986;47:2105–2112.
15.
Boutin C, Viallat JR, Cargnino P, Rey F: Thoracoscopic lung biopsy. Experimental and clinical preliminary study. Chest 1982;82:44–48.
16.
Colt HG, Russack V, Shanks TG, Moser KM: Comparison of wedge to forceps videothoracoscopic lung biopsy. Gross and histologic findings. Chest 1995;107:546–550.
17.
Zompatori M, Bna C, Poletti V, Spaggiari E, Ormitti F, Calabro E, Tognini G, Sverzellati N: Diagnostic imaging of diffuse infiltrative disease of the lung. Respiration 2004;71:4–19.
18.
Poletti V, Chilosi M, Olivieri D: Diagnostic invasive procedures in diffuse infiltrative lung diseases. Respiration 2004;71:107–119.
19.
Nagai S, Handa T, Ito Y, Takeuchi M, Izumi T: Bronchoalveolar lavage in idiopathic interstitial lung diseases. Semin Respir Crit Care Med 2007;28:496–503.
20.
Romagnoli M, Bigliazzi C, Casoni G, Chilosi M, Carloni A, Dubini A, et al: The role of transbronchial lung biopsy for the diagnosis of diffuse drug-induced lung disease: a case series of 44 patients. Sarcoidosis Vasc Diffuse Lung Dis 2008;25:36–45.
21.
Raghu G: Interstitial lung disease: a diagnostic approach. Are CT scan and lung biopsy indicated in every patient? Am J Respir Crit Care Med 1995;151:909–914.
22.
Katzenstein AL, Myers JL: Nonspecific interstitial pneumonia and the other idiopathic interstitial pneumonias: classification and diagnostic criteria. Am J Surg Pathol 2000;24:1–3.
23.
Strieter RM: Pathogenesis and natural history of usual interstitial pneumonia: the whole story or the last chapter of a long novel. Chest 2005;128(5 suppl 1):526S–532S.
24.
Gal AA: Use and abuse of lung biopsy. Adv Anat Pathol 2005;12:195–202.
25.
Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, Colby TV, Cordier JF, Flaherty KR, Lasky JA, Lynch DA, Ryu JH, Swigris JJ, Wells AU, Ancochea J, Bouros D, Carvalho C, Costabel U, Ebina M, Hansell DM, Johkoh T, Kim DS, King TE Jr, Kondoh Y, Myers J, Muller NL, Nicholson AG, Richeldi L, Selman M, Dudden RF, Griss BS, Protzko SL, Schunemann HJ: An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011;183:788–824.
26.
Quadrelli S, Molinari L, Ciallella L, Spina JC, Sobrino E, Chertcoff J: Radiological versus histopathological diagnosis of usual interstitial pneumonia in the clinical practice: does it have any survival difference? Respiration 2010;79:32–37.
27.
Colby TV: Bronchiolitis. Pathologic considerations. Am J Clin Pathol 1998;109:101–109.
28.
Ebina M, Shimizukawa M, Shibata N, Kimura Y, Suzuki T, Endo M, et al: Heterogeneous increase in CD34-positive alveolar capillaries in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2004;169:1203–1208.
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