Pulmonary Procedures |

Transbronchial Biopsies in Lung Cancer: Retrospective Review of 116 Patients FREE TO VIEW

Ping Shi Zhu; Charles D. Poirier; Michel Gagnon; Thomas Vandemoortele
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Department of Respirology CHUM (Centre Hospitalier de l'Université de Montréal) Hôpital Notre-Dame, Montreal, PQ, Canada

Chest. 2014;146(4_MeetingAbstracts):795A. doi:10.1378/chest.1994614
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SESSION TITLE: Bronchoscopy Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Bronchoscopy with transbronchial biopsy (TBB) is an interesting tool in the investigation of lung cancer. We aimed to describe the yield and safety of TBB in the evaluation of pulmonary malignancy.

METHODS: We retrospectively reviewed the data of 116 TBB performed to assess lung lesions executed between January 2013 and December 2013 at a tertiary center. We evaluated these procedures in terms of diagnostic yield for neoplasia and complications.

RESULTS: The mean age of the patients was 66 years old (range 26-88), with 55 males (48.9%). The mean number of biopsies was 4.28 (±1.46). The diagnostic yield from TBB alone for lung cancer was 37.9% (44/116), while when combined with other sampling procedures (such as bronchial biopsy, bronchoalveolar lavage or brush), diagnostic yield was 43.1% (50/116). When linear endobronchial ultrasound (EBUS) was performed during the same procedure, diagnostic yield further increased to 58.6% (68/116). A higher number of biopsies improved the diagnostic yield (72.7% with > 5 biopsies vs 36.7% with 3-5 biopsies vs 0% with 1-2 biopsies; p= 0.015). Diagnostic yield was higher when lesions measured ≥ 30 mm (46.3%; 31/67) compared with nodules <30 mm in diameter (25.6%; 10/39) [p=0.041]. Adjuncts such as radial EBUS (8/116), electromagnetic navigation (19/116), fluoroscopy (17/116) and cryoprobe (4/116) were used in 29 TBB (25%), with no significant effect on diagnostic yield (p=0.659). Location of lung lesion and tissue sample size did not significantly impact the diagnostic yield. The main complication was bleeding (≥ 30 cc or at least moderate as estimated by the bronchoscopist), which was seen in 7 cases (6%). Tranexamic acid and bronchoscopic balloon were required in 2 cases of bleeding. Only one patient suffered from a small pneumothorax (0.9 %) that did not necessitate chest drainage. Specimen size, number of biopsies and adjuncts did not increase the risk of complications.

CONCLUSIONS: Efficacy of TBB for the diagnosis of lung cancer is optimized when performed with linear EBUS, > 5 biopsies and lesions ≥ 30 mm. TBB appears to be a relatively safe procedure, with no significant rise in risk of complications with higher number of biopsies.

CLINICAL IMPLICATIONS: In the assessment of pulmonary malignancy, TBB is more useful with larger lesions. Adding linear EBUS and performing > 5 biopsies significantly enhance the diagnostic yield of TBB for lung cancer.

DISCLOSURE: The following authors have nothing to disclose: Ping Shi Zhu, Charles D. Poirier, Michel Gagnon, Thomas Vandemoortele

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