title: Quality, size, and composition of pediatric endobronchial biopsies in cystic fibrosis.
abstract: BACKGROUND
  Studies on airway remodeling in children with cystic fibrosis (CF) may be hampered by difficulty in obtaining evaluable endobronchial biopsy specimens because of large amounts of mucus and inflammation in the CF airway. We prospectively assessed how the quality of biopsy specimens obtained from children with CF compare with those from children with other airway diseases.
  
  
  METHODS
  Fiberoptic bronchoscopy with endobronchial biopsy was performed in 67 CF children (age range, 0.2 to 16.8 years), 34 children with wheeze/asthma (W/A), and 64 control children with chronic respiratory symptoms. Up to three biopsy specimens were taken and stained with hematoxylin and eosin. Biopsy specimen size and structural composition were quantified using stereology.
  
  
  RESULTS
  At least one evaluable biopsy specimen was obtained in 72% of CF children, in 79% of children with W/A, and in 72% of control subjects (difference was not significant). The use of large biopsy forceps (2.0 mm) rather than small biopsy forceps (1.0 mm) [odds ratio (OR), 5.8; 95% confidence interval (CI), 1.1 to 29.8; p = 0.037] and the number of biopsy specimens taken (odds ratio, 2.6; 95% confidence interval, 1.3 to 5.2; p = 0.006) significantly contributed to the success rate. Biopsy size and composition were similar between groups, except that CF children and those patients with W/A had a higher percentage of the biopsy specimen composed of muscle than did control subjects (median 6.2% and 9.7% vs 0.9%, respectively; p = 0.002).
  
  
  CONCLUSIONS
  Biopsy size and quality are adequate for the study of airway remodeling in CF children as young as 2 months of age. Researchers should use large forceps when possible and take at least two biopsy specimens per patient. An increased airway smooth muscle content of the airway mucosa may contribute to the pathophysiology of CF lung disease.
authors.affiliation: Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK. N.Regamey@imperial.ac.uk
authors.forename: Nicolas
authors.initials: N
authors.lastname: Regamey
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Hilliard
authors.forename: Sejal
authors.initials: S
authors.lastname: Saglani
authors.forename: Jie
authors.initials: J
authors.lastname: Zhu
authors.forename: Mike
authors.initials: M
authors.lastname: Scallan
authors.forename: Ian M
authors.initials: IM
authors.lastname: Balfour-Lynn
authors.forename: Marc
authors.initials: M
authors.lastname: Rosenthal
authors.forename: Peter K
authors.initials: PK
authors.lastname: Jeffery
authors.forename: Eric W F W
authors.initials: EW
authors.lastname: Alton
authors.forename: Andrew
authors.initials: A
authors.lastname: Bush
authors.forename: Jane C
authors.initials: JC
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000473:pathology; D001706:Biopsy / Q000592:standards; D001980:Bronchi / Q000473:pathology*; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003550:Cystic Fibrosis / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D008171:Lung Diseases / Q000473:pathology; D008297:Male; D009130:Muscle, Smooth / Q000473:pathology; D011446:Prospective Studies; D011786:Quality Control; D012307:Risk Factors; D012720:Severity of Illness Index