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