Comparison of forceps used for transbronchial lung biopsy. Bigger may not be better

Transbronchial lung biopsy is a useful procedure to obtain an alveolar specimen in the evaluation of diffuse lung infiltrates. Large forceps (cup and alligator) are expected to result in larger specimens and improve diagnostic yield. We performed transbronchial lung biopsy in 20 patients using two different sized forceps in each patient. We compared the histology and histopathologic diagnoses obtained by small cup forceps, large cup forceps, and large alligator forceps. Small and large cup forceps provided equally good results; however, the large open end of the alligator forceps often prevented distal passage through narrowing airways, engaging proximal bifurcating bronchial wall and cartilage rather than lung parenchyma. Small and large cup forceps are more likely to obtain the desired alveolar specimen.