EFFICACY OF TRANSBRONCHIAL BIOPSY IN PULMONARY VASCULITIDES

This study was performed to determine the value of transbronchial biop sy (TBB) in patients with antineutrophil cytoplasmic antibody (ANCA)-a ssociated vasculitides and mild-to-moderate pulmonary involvement. Inc luded in the study were 19 patients with Wegener's granulomatosis (WG) and six patients with Churg-Strauss syndrome (CSS) with evidence of a ctive pulmonary disease but without gross parenchymal lesions accessib le by radiologically guided biopsy. All of the patients had undergone staging examinations which included TBB taken from peripheral lung tis sue and from any focal tracheobronchial lesions, Any suspicious lesion in the upper respiratory tract was biopsied by an otolaryngologist an d the number of positive biopsies was compared with that of TBB. In th e WG patients, only two out of 17 biopsies of alveolar tissue yielded histopathological findings supporting the diagnosis of WG. In five WG patients, ulcerative or exophytic airway lesions were found whose hist opathologies were invariably positive. Otolaryngological examination r evealed abnormal findings in 19 WG patients and biopsies from these si tes yielded positive results in 13 instances, In CSS, TBB produced a d iagnostically helpful histopathology in four of sis cases and biopsies from the upper respiratory tract were positive in five out of sis cas es, We conclude that transbronchial biopsies of alveolar tissue are se ldom positive in Wegener's granulomatosis patients with mild-to-modera te pulmonary disease unless they are taken from grossly abnormal lung areas, Conversely, ulcerative, exophytic or stenotic tracheobronchial lesions had a high rate of positive findings, These results further su ggest that the upper rather than the loner respiratory tract should be the biopsy site of first choice in Wegener's granulomatosis. In Churg -Strauss syndrome, the upper and lower respiratory tract seem to yield a roughly equal number of positive biopsies.