Interpretation of tissue artifacts in transbronchial lung biopsy specimens

Proper interpretation of transbronchial biopsies is critical for appropriate patient management. Artifacts in lung tissue acquired during the biopsy procedure or subsequent processing may mimic "true" disease and potentially lead to incorrect diagnoses. In this study the interpretation of various artifacts in transbronchial biopsies will be correlated with the level of pathologist training and experience. Minced 1 to 2 mm fragments of normal lung tissue were processed to produce various tissue artifacts (atelectasis, sponge artifact, or bubble artifact). Seven hematoxylin-eosin-stained slides of various artifacts and three similar-appearing slides from "true" pulmonary diseases (lipoid pneumonia, usual interstitial pneumonia, and foreign body reaction) were evaluated by eight pathologists of different levels of training and experience. Most pathologists were unaware of the various artifacts in transbronchial biopsies and were occasionally able to differentiate them from true disease. Senior faculty frequently identified and correctly diagnosed the true pathology slides; however, they often failed to recognize artifacts. Junior faculty performed the best by correctly identifying the majority of true pathology and dismissed most artifacts. Junior and senior residents described the microscopic changes, but had more difficulty determining the significance of both true pathology and artifacts. Various artifacts in transbronchial biopsy specimens can create diagnostic dilemmas for all pathologists regardless of level of training. The elimination of these artifacts should reduce the possibility of biopsy misinterpretation.