Legal Aspects of Endobronchial and Transbronchial Biopsy
Timothy C. Allen MD, JD
Clinicians’ medicolegal concerns about transbronchial and endobronchial biopsies generally arise from medical complications such as severe pneumothorax and severe bleeding. Pathologists also have to be cognizant of medicolegal consequences arising from the biopsies’ diagnoses. Appropriate accessioning of the biopsy, gross examination, processing, and careful microscopic review are necessary as with any other surgical pathology specimen. For several issues specific to endobronchial and transbronchial biopsies, appropriate attention will help assure a correct diagnosis and allay medicolegal concerns as well.
The self-expectation or clinician pressure to render a diagnosis does not abrogate the pathologist’s responsibility to identify artifacts, normal variations, nonspecific changes, and limited, nonrepresentative samples and therefore appropriately limit the diagnosis, even to the extent that no diagnosis is possible. Correlation with clinical and radiologic features helps avoid overinterpretation of the biopsy tissue.
Endobronchial and transbronchial biopsies are by definition specimens consisting of small fragments of tissue, often with associated blood. Specimen adequacy is a principal concern. Specimens labeled as endobronchial biopsies, for which the clinician may be primarily concerned with preneoplasia or another endobronchial process, may contain underlying lung parenchymal tissue in which focal or subtle pathologic changes are present. If an endobronchial biopsy contains little or no intact mucosa due to mucosal sloughing or crush or other artifact, the specimen is not representative of the patient’s airway mucosa and bronchial wall and is unsatisfactory for the determination of preneoplasia. Such a finding should be noted in the microscopic description or diagnosis, and no opinion regarding preneoplasia in the specimen should be rendered.