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Abumossalam A. M. et al, who conducted this research in human development and clinical trial at pulmonary and critical medicine department, Faculty of medicine, Mansoura university, analyzed data on one hundred and seventeen patients with radiological pulmonary shadows who were submitted for fiberoptic bronchscopy and underwent conventional TBLB that was supported by prior localization with chest computed tomography in 84 patients as a one group and under a real-time transthoracic ultrasound guided transbronchial lung biopsy in 33 patients as second group, provided those lesions were in central locations with accessible sonographic window with convex probe for more deeper access. The procedure was operated at the same time regarding fiberoptic bronchoscopy and transthoracic ultrasound techniques. Transthoracic ultrasound guided transbronchial lung biopsy achieved diagnosis in 81.81% of cases conducted and conventional transbronchial lung biopsy achieved diagnosis in 71.43%.
This maneuver substituted endobronchial ultrasound with less invasive attitude and less radiation exposure, computed tomography or fluoroscopic guided assistance especially with appropriate patients' selection to undertake biopsy on an equal footing for nonneoplastic as well as neoplastic conditions.
Even if no major complications were encountered in a series by Zavala, 1976 in a study conducted on 438 patients, certain safety measures were essential. Suction must be used in moderation to avoid hypoxemia, and supplemental oxygen should be available during the procedure, the incidence of bleeding was 9%. If the coagulation mechanism was significantly altered, then specific therapy must be instituted prior to biopsy to prevent serious hemorrhage. In Abumossalam study, out of the 117 cases (4.2%) developed complications that were in the form of residual pneumothorax in 3 patients, 2.5% and haemoptysis in two patients 1.7% that was controlled by haemostatics lacking surgical intervention. No cases of mortality were recorded.
Additional co-authors were lecturers Taha Taha Abdelgawad, Amro Abdelhamid Moawd, pulmonary and critical medicine department, Faculty of medicine, Mansoura university and Abdelhadi Mohammed Shebl, Pathology department, Faculty of medicine, Mansoura University, Mansoura, Egypt.
Zavala DC: Pulmonary hemorrhage in fiberoptic transbronchial biopsy. Chest. 1976, 50:584,
Figure (1) Biopsy forceps needle echogenic line imaged during sampling of central pulmonary mass with mediastinal invasion.