Hot and Cold Biopsy Forceps in the Diagnosis of Endobronchial Lesions

Study Overview
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Brief Summary
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A new electrocautery bronchoscopy biopsy forceps is now commercially available and may prevent bleeding following biopsy. Only one study used this device wherein the authors concluded that the use of hot biopsy forceps for endobronchial biopsy does not appear to have a negative impact on the pathological samples, and that there was a statistically significant, albeit clinically insignificant reduction in bleeding score with hot biopsy forceps. Therefore, a randomized controlled study is required in which the hot and cold biopsies are performed to evaluate the tissue effect of the hot biopsy forceps on histopathological diagnosis.

Detailed Description
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In recent years, a number of innovative non-thoracotomy techniques have been introduced for the diagnosis of indeterminate pulmonary disease but none has had greater impact on pulmonary medicine than flexible fiberoptic bronchoscopy. Since its introduction in 1968, fiberoptic bronchoscopy has become the procedure of choice for diagnosis and management of many bronchopulmonary disorders. It is accompanied by a low incidence of complications and can be performed satisfactorily by the transnasal approach without general anesthesia. Donlan et al, in 1978, and Ackart and colleagues, in 1983, demonstrated the safety of fiberoptic bronchoscopy as an outpatient procedure. Transbronchial biopsy was first attempted, through a rigid bronchoscope in 1965, but was associated with a high occurrence of pneumothorax. Reports began to appear from 1974 onwards of lung biopsies done for diffuse pulmonary disease using the standard fiberoptic bronchoscope. Forceps biopsy through flexible bronchoscopy is commonly used to make the cytological or histological diagnosis. Of the procedures performed through bronchoscopy, forceps biopsy provides the best diagnostic yield of 71% to 93%. A new electrocautery ''hot'' bronchoscopy biopsy forceps is now commercially available and may prevent bleeding following biopsy. Only one study used this device wherein the authors concluded that the use of hot biopsy forceps for endobronchial biopsy does not appear to have a negative impact on the pathological samples, and that there was a statistically significant (albeit clinically insignificant) reduction in bleeding score with hot biopsy forceps. However, limitations in this study were small sample size, use of hot and cold biopsy in the same patient as well as interval between the two biopsies were short due to which it is difficult to decide which technique has contributed to the bleeding. Therefore, a randomized controlled study is required in which the hot and cold biopsies are performed to evaluate the tissue effect of the hot biopsy forceps on histopathological diagnosis.

Official Title
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Hot and Cold Biopsy Forceps in the Diagnosis of Endobronchial Lesions

Conditions
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Endobronchial Growth, Lung Cancer

Intervention / Treatment
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* Device: Hot biopsy forceps
* Device: Cold biopsy forceps


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients undergoing routine bronchoscopic biopsy for various indications More than 18 years of age Exclusion Criteria: Bleeding diathesis On pacemaker or implanted defibrillator On anticoagulation therapy Poor cardiopulmonary reserve Marked hypoxemia Uncooperative patient Enrollment in the previous study

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Hot biopsy<br>Hot biopsy i.e. Endobronchial biopsies taken with the application of an electrocoagulation current by an electrocoagulation-capable biopsy forceps | Device: Hot biopsy forceps<br>* Endobronchial biopsies taken with the application of an electrocoagulation current by an electrocoagulation-capable biopsy forceps<br>* Other names: Hot biopsy;|
| Active Comparator: Cold biopsy<br>Cold biopsy i.e. Endobronchial biopsies taken without the application of an electrocoagulation current by an electrocoagulation-capable biopsy forceps | Device: Cold biopsy forceps<br>* Endobronchial biopsies taken without the application of an electrocoagulation current by an electrocoagulation-capable biopsy forceps<br>* Other names: Cold biopsy;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of pathological specimen |  | 4 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Severity of bleeding |  | During procedure | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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endobronchial biopsy, bronchoscopy, interventional pulmonology