Hot biopsy forceps in the diagnosis of endobronchial lesions

Electrocoagulation bronchoscopy biopsy forceps may prevent bleeding, but could also impair the quality of the specimens obtained. Patients with endobronchial lesions during bronchoscopy underwent six endobronchial biopsies each with a hot biopsy forceps, alternating between with electrocoagulation ("hot") and without ("cold"). Bleeding was quantified on a scale of 1-4, with 1 being no bleeding. The generator was set on "soft coagulation" mode, with power settings of 40, 60, 80 and 100 W for each group of 10 patients in a sequential fashion. Clinical pathology results were recorded before samples were reviewed by a second, blinded, pulmonary pathologist. A total of 39 patients with 40 endobronchial lesions had six biopsies performed (one patient had only four samples taken), giving a total of 238 biopsy samples. Concordance between hot and cold samples was 92.5% for the clinical pathologist and 87% for the blinded pathologist. Paired analysis suggested lower average bleeding score with the use of hot forceps. Overall bleeding rates for cold and hot biopsies, respectively, were as follows: grade 1: 30.3 and 41.2%; grade 2: 62.2 and 49.6%; grade 3: 7.6 and 9.2%; and grade 4: 0 and 0%. In conclusion, the use of hot biopsy forceps for endobronchial biopsy does not appear to have a negative impact on the pathological samples. Hot biopsy forceps showed a statistically significant reduction in bleeding score, which is unlikely to be of clinical significance.