Transbronchial Biopsies in Lung Cancer: Retrospective Review of 116 Patients

Abstract

Background: 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 male (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 g 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 l30 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). Only one patient suffered from a small pneumothorax (0.9 %) that did not require chest drainage. Conclusions: Efficacy of TBB for the diagnosis of lung cancer is optimized when performed with linear EBUS, g 5 biopsies and larger lung lesion.