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    Respiratory small biopsies


    Pulmonary needle biopsies, video-assisted thoracoscopic (VATS) and open pulmonary (surgical lung) biopsies are all methods for investigating pulmonary disease such as pneumonia and tumours.1

    For wedge biopsies, see the lung protocol.

    Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

    The potential for an infectious biohazard should always be considered with fresh specimens but particularly with respiratory samples due to the possibility of mycobaterial infections.1 Ensure strict safe specimen handling and decontamination protocols are in place in the laboratory.

    See general information for more detail on specimen handling procedures.

    Inspect the specimen and dictate a macroscopic description.

    Follow best practice procedures to minimise cross over contamination of small fragments to other specimens.2

    External Inspection

    Describe the following features of the specimen:1


    Record as stated by the clinician.

    • Video-assisted thoracoscopic (VATS) biopsy1
    • Open biopsy –for lung wedge biopsies, see the lung protocol
    • Needle biopsy
    • Transthoracic needle biopsy3
    • Incisional biopsy
    • Other, describe4,5

    Biopsy site

    • Lung
    • Pleura
    • Bronchus
    • Mediastinal mass
    • Other, describe

    Number of pieces*

    • Record the number of pieces of tissue received

    Specimen dimensions (mm)

    • Each fragment in three dimensions
    • Where multiple fragments are present, the range of maximum sizes may be appropriate*

    *“Multiple” should only be used to describe specimens where biopsies are too numerous to count.

    Colour (more than one may apply)

    • Tan
    • Red
    • Yellow
    • White

    Consistency (more than one may apply)

    • Firm
    • Soft
    • Polypoid
    • Friable


    Not required.

    Internal Inspection

    Not required.


    Submit all tissue directly into cassettes for processing. Biopsy pads, lens paper or similar are required to prevent loss of tissue during processing.

    Record details of each cassette.

    An illustrated block key similar to the one below may be useful.

    Block allocation key

    Cassette id
    No. of pieces
    Bronchial bx


    Dr Jenny Ma Wyatt for her contribution in reviewing and editing this protocol.


    1. Nicholson AG. Tissue pathway for non-neoplastic thoracic pathology, The Royal College of Pathologists, London, 2013.
    2. Lester SC. Extraneous Tissue. In: Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010;33-34.
    3. Lester SC. Small Biopsies. In: Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010;243-245.
    4. Nicholson AG, Kerr K, Gosney J and Cane P. Dataset for the histological reporting of thymic epithelial tumours, The Royal College of Pathologists, London, 2013.
    5. Marchevsky A, Marx A, Strobel P, Suster S, Venuta F, Marino M, Yousem S and Zakowski M. Policies and reporting guidelines for small biopsy specimens of mediastinal masses. J Thorac Oncol 2011;6: S1724-1729.

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      Resp small bx 1

      Transbronchial biospies

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