PURPOSE: Pneumothorax is the most common complication of transbronchial biopsy. Previous studies examining the safety of transbronchial biopsy with or without fluoroscopy have found no difference. The British Thoracic Society advocates the use of fluoroscopy during transbronchial biopsy. However neither the American College of Chest Physicians nor the American Thoracic Society have definitive guidelines. This study evaluates the rates of transbronchial biopsy-induced pneumothorax with and without fluoroscopy.
METHODS: All transbronchial biopsies performed at UCSF-Fresno from 2007 to 2010 by pulmonary fellows with attending supervision were reviewed. We compared the rate of transbronchial biopsy-induced pneumothorax with and without fluoroscopy. The odds ratio and confidence interval were calculated using PASW software. We performed a Chi-squared test with the Fisher’s exact correction. A p-value of <0.05 was considered statistically significant.
RESULTS: 130 transbronchial biopsies were reviewed. 82 were done without fluoroscopy and 48 were done with fluoroscopy. We found an 11% (9/82) incidence of pneumothorax in cases without fluoroscopy, compared to a 2% (1/48) incidence in cases with fluoroscopy. Odds ratio, 5; 95% CI 0.7-40 (p-value 0.09).
CONCLUSIONS: Our study shows a trend for decreasing risk of transbronchial biopsy-induced pneumothorax when fluoroscopy is used.
CLINICAL IMPLICATIONS: The use of fluoroscopy may decrease the rate of transbronchial biopsy-induced pneumothorax. Our study suggests that transbronchial biopsy without fluoroscopy may not be as safe as previously thought.
DISCLOSURE: The following authors have nothing to disclose: David Collins, Gurinder Sidhu, Jose Joseph
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