Procedures: Procedures 2 |

Characteristics and Outcomes of Endobronchial Ultrasound/Transbronchial Needle Aspiration in Patients With Congestive Heart Failure and End-stage Renal Disease FREE TO VIEW

Ji Yeon Lee; David Berkowitz; Keriann Van Nostrand, MD
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Emory University, Decatur, GA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1022A. doi:10.1016/j.chest.2016.08.1128
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SESSION TITLE: Procedures 2

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Thoracic lymphadenopathy can be present in greater than thirty percent of patients with end-stage renal failure (ESRD) or congestive heart failure (CHF). However, biopsies may be risky as ESRD and CHF have been associated with increased risk of surgical complications. The objective of this study is to characterize biopsy results and patient outcomes in patients with ESRD and CHF undergoing endobronchial ultrasound (EBUS) with transbronchial needle aspiration (TBNA).

METHODS: Adult patients with a history of CHF or ESRD, documented prior to procedure or on the same inpatient admission, who underwent EBUS/TBNA for diagnostic purposes were evaluated retrospectively. The procedure was performed during October 2012 to October 2015 at either Emory University or Emory Midtown Hospital. Basic demographic information, history of malignancy, smoking status, imaging findings of volume overload, presence of lung mass/nodule, inpatient status, node location, node size, presence of trainee, complications, biopsy results, and use of anesthesia were collected. Statistical tests were performed using t-test and Fisher’s exact test as appropriate.

RESULTS: 52 procedures from 50 patients were included with a total of 117 lymph nodes biopsied. The mean size of the lymph nodes biopsied was 16 millimeters (mm). 68 lymph nodes were benign, 19 malignant, 16 nondiagnostic, and 14 with other diagnoses. When compared to benign lymph nodes, malignant lymph nodes were associated with older age (71 vs 62 years, p = 0.001), larger lymph node size (25 vs 16 mm, p < 0.001), and inpatient admission (78% vs 63%, p = 0.013). There were no lymph nodes smaller than 10 mm that were malignant. Malignancy was also associated with a high risk smoking status (79% vs 28%, p < 0.001). Although the presence of a lung mass or nodule did not correlate with malignancy, the size of the lesion did (54 vs 27 mm, p < 0.001). African American race (56% vs 86%, p = 0.01), and deep sedation use (68% vs 82%, p = 0.001) were associated with lower risk of malignancy. History of malignancy and presence of trainee were not significantly different. Presence of volume overload on imaging trended toward decreasing incidence of malignancy but was not statistically significant (26% vs 44%, p = 0.09). Complications occurred in 10 out of 52 procedures (19%). Complications included hypoxic and hypercapnic respiratory failure, altered mental status, hypotension, sepsis, cardiac arrest, minor bleeding, SVT, and bradycardia. Almost all events required inpatient admission, usually to the intensive care unit.

CONCLUSIONS: Lymph nodes less than 10 mm are less likely to be malignant in patients with thoracic lymphadenopathy and CHF/ESRD. Older age, larger lymph node size, inpatient admission, high risk smoking status, and larger size of a lung mass were associated with malignancy. Complication rates were high in this cohort compared to published data with complication rates less than 2%.

CLINICAL IMPLICATIONS: In patients with CHF/ESRD, judicious patient selection for EBUS/TBNA may be warranted based on the risk factors mentioned above, considering the high complication rate noted in this study. Larger studies are needed to validate these results.

DISCLOSURE: The following authors have nothing to disclose: Ji Yeon Lee, David Berkowitz, Keriann Van Nostrand

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