Abstract
BackgroundThe risk of endobronchial ultrasound-guided transbronchial biopsy-related pneumothorax is a major concern and warrants further studies. The aim of our study was to estimate the risk of pneumothorax after this procedure and identify its risk factors.MethodsFrom 2007 to 2011, 399 patients who underwent endobronchial ultrasound-guided transbronchial biopsy for peripheral lung lesions were included in this study. The variables analyzed included patient factors, lesion factors and procedure factors. Multivariate logistic regression analysis was used to identify independent risk factors for pneumothorax.ResultsThe incidence of pneumothorax was 3.3% (13/399). Chest tube placement was required for 31% (4/13) of pneumothoraces. Independent risk factors for pneumothorax included pulmonary emphysema (OR, 55.09; 95% CI, 9.37–324.03; p<0.001) and probe position adjacent to the lesion (OR, 17.01; 95% CI, 2.85–101.64; p = 0.002). The number of biopsy specimens, age, sex, history of prior lung surgery and lesion size, location and character did not influence the risk of pneumothorax in our analyses.ConclusionsThe risk of pneumothorax after endobronchial ultrasound-guided transbronchial biopsy is low. To further reduce the risk of pneumothorax, every effort should be made to advance the endobronchial ultrasound probe into the bronchus where it is imaged within the target lesion before embarking on transbronchial biopsy.
Highlights
Since its advent, endobronchial ultrasound (EBUS) has been widely used to increase the diagnostic yield of transbronchial biopsy for peripheral lung lesions and has had a favourable safety profile
Study Subjects From January 2007 to December 2011, all patients who underwent EBUS-guided transbronchial lung biopsy (TBB) for peripheral lung lesions and had a post-procedure chest x-ray at the National Taiwan University Hospital were identified from our bronchoscopy registry and were the study subjects
The independent risk factors for pneumothorax in increasing order of p values obtained in a multivariate logistic regression model (Table 3) were pulmonary emphysema (OR, 55.09; 95% CI, 9.37–324.03; p,0.001) and probe adjacent to the lesion (OR, 17.01; 95% CI, 2.85–101.64; p = 0.002)
Summary
Endobronchial ultrasound (EBUS) has been widely used to increase the diagnostic yield of transbronchial biopsy for peripheral lung lesions and has had a favourable safety profile. [4] The patients’ risk of developing pneumothorax after EBUS-guided transbronchial lung biopsy (TBB) may be identified using risk factor analysis; it has not been systematically investigated, to our knowledge. The purpose of this study was to evaluate the risk factors for pneumothorax following EBUS-guided TBB in a large population. Potentially modifiable risk factors associated with pneumothorax were sought in the hope of minimizing pneumothorax. The risk of endobronchial ultrasound-guided transbronchial biopsy-related pneumothorax is a major concern and warrants further studies. The aim of our study was to estimate the risk of pneumothorax after this procedure and identify its risk factors
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