Transbronchial biopsy looks riskier in the upper lobes

  • Herout V & al.
  • BMC Pulm Med
  • 1 Mar 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • During transbronchial biopsy (TBB) in patients with diffuse pulmonary disease, left upper-lobe sampling is associated with higher pneumothorax risk.
  • Limiting sampling to right lower lobe for patients with diffuse disease might be safer.

Why this matters

  • TBB is complicated by pneumothorax about 1%-6% of the time. 
  • A previous study linking this outcome to upper-lobe sampling was underpowered. 

Key results

  • 6.16% (49 patients) experienced pneumothorax; 55% required chest tube.
  • On multivariate analysis, patients experiencing pneumothorax were likelier to have (ORs; 95% CIs):
    • Lower BMI: 1.08 (CI, 1.02-1.16; P=.01).
    • ≥4 samples taken during biopsy: 1.91 (1.04-3.49; P=.04).
    • Left upper-lobe sampling: 2.15 (1.13-4.11; P=.02).
  • Right lower lobe was least likely sampling site to result in pneumothorax (P=.04).

Study design

  • Analysis of all TBBs at a university hospital from 2015 to 2017 (n=796).
  • Authors analyzed clinical and demographic data to determine predictors of pneumothorax. 
  • Outcome: pneumothorax incidence.
  • Funding: Ministry of Health, Czech Republic; National Program of Sustainability II; FNUSA-International Clinical Research Center.

Limitations

  • Retrospective study with small event numbers; no fragility index calculated.
  • Biopsies were not fluoroscopy-guided.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit