PURPOSE: Pulmonary complications are a major cause of morbidity and mortality in cancer patients. The additive clinical benefit of transbronchial biopsy in cancer patients is unclear.
METHODS: Consecutive patients who underwent transbronchial biopsies from June 2008 to December 2010 were reviewed. Clinical history and laboratory data were extracted and analysed.
RESULTS: Eighty patients (M=39, F=41) underwent flexible bronchoscopy with transbronchial lung biopsies. Patient were categorized according to their cancer diagnosis, specifically solid (n=40) and hematologic (n=40) malignancies. The solid tumors consisted mostly of breast (n=12), lung (n=10), head & neck (n=6) and other (n=12) cancers. Hematologic malignancies included lymphoma (n=25), leukemia (n=11) and multiple myeloma (n=4). Disease activity was categorized in each patient. In both groups, actively treated cancer (Solids=21, Hematologic=21) was the most prevalent, followed by patients currently in remission (Solids=19, Hematologic=19). Of note, there were 8 patients with hematologic malignancies who underwent hematopoietic stem cell transplantation. The presence of an infiltrate (n=50) and pulmonary nodules (n=11) were the most common indications for the procedure. Seventy-six patients received moderate sedation by the pulmonologist, 3 underwent general anesthesia with laryngeal mask airway and 1 patient did not received any sedation. The bronchoscope was inserted transnasally in 73 patients. In 76 patients biopsies were obtained from a single lobe. Bronchoalveolar lavage was performed on all patients. Additional procedures included endobronchial biopsy/brushing (n=9) and transbronchial needle aspiration (n=3). Biopsy results influenced clinical care in most patients (n=63). In solid tumors, samples yielding normal lung tissue (n=13) and cancer (n=9) directed further management, while in hematologic malignancies, pathology with inflammatory changes (n=12) and normal lung (n=9) altered clinical care. Additional diagnostic procedures were required in only 4 patients. Complications occurred in 4 patients including pneumothorax, and one of these patients also had a transient ischemic attack immediately after the procedure.
CONCLUSIONS: Transbronchial biopsies performed in cancer patients may provide useful clinical information without excessive risk.
CLINICAL IMPLICATIONS: Transbronchial biopsies are a reasonable diagnostic tool in selected cancer patients with pulmonary abnormalities.
DISCLOSURE: The following authors have nothing to disclose: Paresh Patel, Lara Bashoura, George Eapen, Archan Shah, Vickie Shannon, Rodolfo Morice, Saadia Faiz
No Product/Research Disclosure Information