There are three major lung biopsy specimen types that may be received in the laboratory.
Open lung biopsy (sometimes labeled “Thoracoscopic”)
This specimen usually consists of a wedge of lung tissue obtained during surgery and submitted in a clean, sterile container.
Trans-thoracic needle biopsy
These specimens are taken by pushing a small bore needle through the chest wall into the lung and aspirating the contents of the needle into a small amount of fluid.
Trans-bronchial lung biopsy
These specimens are taken using a fiberoptic bronchoscope and removing a portion of lung tissue. A much smaller piece of tissue is obtained than with open lung biopsy.
Prepare smears for:
- Gram stain
- KOH Calcoflour stain
- Auramine stain
- 1 extra smear for potential special stains
|Blood Agar (BA)||CO2, 35°C x 48 hours|
|Chocolate Agar (CHOC)||CO2, 35°C x 48 hours|
|MacConkey Agar (MAC)||O2, 35°C x 48 hours|
|Wilkins Chalgren Agar (WC)||AnO2, 35°C x 48 hours|
|WC Nalidixic acid – Tween 80 (NAT)||AnO2, 35°C x 48 hours|
|WC Nalidixic acid – Vancomycin (NAV)||AnO2, 35°C x 48 hours|
|Thioglycolate broth (THIO)||O2, 35°C x 48 hours|
|Sabouraud’s Heart Infusion Agar (SABHI)||O2, 30°C x 4 weeks|
|SABHI with Chloramphenicol (SABHI-C)||O2, 30°C x 4 weeks|
If B. cepacia is requested or specimen is from a patient with Cystic Fibrosis, add:
|*Burkholderia cepacia* Agar (BC)||O2||35°C x 3 days|
Keep the BA, CHOC and MAC plates CO2 35°C x 3 days
If Nocardia is requested, add:
|Vancomycin Colistin Nalidixic acid (VCN)||CO2||35°C x 5 days|
If no growth on aerobic and anaerobic plates, but organisms resembling anaerobic organisms are seen on Gram stain, re-incubate the WC, NAT, NAV and THIO for an additional 48 hours.
Examine the BC plate daily for 3 days.
Report with quantification.
KOH Calcofluor Stain
Report fungal elements seen or not seen.
Report acid-fast bacilli with quantification or acid-fast bacilli not seen.
- “No growth.”
- “No B. cepacia isolated” if B. cepacia culture is requested.
- “No Nocardia isolated” if Nocardia culture is requested.
- Report all isolates with appropriate susceptibilities.
- Telephone all positive results of direct examination and culture to ward / ordering physician.
H.D. Izenberg. 2003. Respiratory Tract Cultures, 18.104.22.168 – 22.214.171.124 in Clinical Microbiology Procedures Handbook, 2nd ed. Vol.1 ASM Press, Washington, D.C.