Transbronchial biopsy from the upper pulmonary lobes is associated with increased risk of pneumothorax \u2013 a retrospective study

Kristian Brat,Michaela Heroutova,Zdenek Merta,Vladimir Herout,Ivan Cundrle Jr

doi:10.1186/s12890-019-0820-z

Kristian Brat, Michaela Heroutova + Show 3 more

Open Access

https://doi.org/10.1186/s12890-019-0820-z

Copy DOI

Abstract

BackgroundPneumothorax (PTX) is one of the most common complications of transbronchial biopsy (TBB). Previous research suggests that upper pulmonary lobe TBB may be associated with increased risk of PTX development. The aim of this study was to compare the risk of PTX after TBB performed from different pulmonary lobes.MethodsAll bronchoscopic records from the period January 1st, 2015 - December 31st, 2017 (from the Department of Respiratory Diseases, University Hospital Brno, Czech Republic) were retrospectively analyzed. Of the 3542 bronchoscopic records, 796 patients underwent TBB and were further analyzed. Basic demographic data, TBB procedure-related factors, smoking history and radiological features were analyzed. Furthermore, in patients who developed PTX, PTX onset, PTX symptoms, distribution of the abnormal radiological findings and duration of hospitalization were also analyzed.ResultsPatients who developed PTX had significantly lower body mass index (BMI) and more than 4 samples taken during procedure (all p < 0.05). TBB performed from the left upper pulmonary lobe was associated with a significant risk of PTX development (OR 2.27; 95% CI 1.18–4.35; p = 0.02). On the contrary, TBB performed from the right lower lobe was associated with a significant reduction of risk of developing PTX (OR 0.47; 95% CI 0.22–0.98; p = 0.04). Logistic regression analysis showed BMI (OR 1.08; 95% CI 1.02–1.16; p = 0.01), left upper lobe as sampling site (OR 2.15; 95% CI 1.13–4.11; p = 0.02) and more than 4 samples taken (OR 1.91; 95% CI 1.04–3.49; p = 0.04) to be significantly associated with PTX development.ConclusionsWe conclude that TBB from the left upper pulmonary lobe is associated with significantly increased risk of post-procedural PTX. The right lower pulmonary lobe seems to be the safest sampling site to perform TBB. In patients with diffuse-type pulmonary disease, TBB should be performed preferably from the right lower lobe in order to decrease the risk of post-procedural PTX.

Highlights

Pneumothorax (PTX) is one of the most common complications of transbronchial biopsy (TBB)
In a study by Huang et al, TBB performed from the upper pulmonary lobes tended to be a potential risk factor for PTX development when compared to other locations [4]
We suggest that in case the TBB could not be performed from the lower lobes it should at least increase the awareness of PTX development

Summary

Introduction

Pneumothorax (PTX) is one of the most common complications of transbronchial biopsy (TBB). Previous research suggests that upper pulmonary lobe TBB may be associated with increased risk of PTX development. The aim of this study was to compare the risk of PTX after TBB performed from different pulmonary lobes. Transbronchial lung biopsy (TBB) is a procedure performed during flexible bronchoscopy with the use of biopsy forceps. The most common complications of TBB are pneumothorax (PTX) and bleeding. The incidence of PTX after TBB was reported to be 1–6% [3]. In a study by Huang et al, TBB performed from the upper pulmonary lobes tended to be a potential risk factor for PTX development when compared to other locations [4]. In this study, the group of patients with PTX was too small to gain statistical significance [4, 5]

Objectives

Methods

Results

Discussion

Conclusion