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Quantitative morphology using bronchial biopsies

The Division of Pulmonary and Critical Care Medicine, Dept of Medicine and Cardiovascular Research Institute, University of California, San Francisco, CA, USA.

CORRESPONDENCE: P. G. Woodruff, Box 0111, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA. Fax: 1 4154765712. E-mail: prescott.woodruff{at}ucsf.edu

Bronchoscopy with bronchial biopsies allows sampling of airway tissue in prospective clinical studies and is increasingly applied for the study of airway inflammation and remodelling.

It is important to recognise that there are limitations inherent to the use of bronchial biopsies, including the inability to randomly sample the airway and susceptibility to the "reference trap". Nonetheless, certain stereological principles can be applied to the analysis of these specimens, which may improve the validity of the results obtained. These principles relate to choice of reference space, adequacy of sampling and treatment of tissue orientation in the estimation of thickness and surface area.

With attention to these principles, the present authors have developed protocols for the assessment of multiple measures of airway remodelling in bronchial biopsies, including airway epithelial mucin content, epithelial goblet cell size, reticular basement membrane thickness and smooth muscle morphological outcomes. They have also developed protocols for the enumeration of inflammatory cells important in the study of asthma and chronic obstructive pulmonary disease, including eosinophils and neutrophils.

In the present article, relevant stereological principles and the details of these specific protocols will be reviewed.

KEYWORDS: Airway remodelling, bronchial biopsy, inflammation, morphometry, stereology