Chest
Volume 94, Issue 3, September 1988, Pages 557-560
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Transbronchial Biopsy without Fluoroscopy: A Seven-year Perspective

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The use of fluoroscopic guidance for transbronchial biopsy (TBB) during flexible fiberoptic bronchoscopic examination has been controversial. Patient records and bronchoscopy reports for 112 transbronchial biopsies performed with fluoroscopy over a seven-year period were reviewed and compared with those of 135 transbronchial biopsies performed without fluoroscopy over the same interval. Complication rates with regard to pneumothorax, fever, and hemorrhage were compared, as were yield data for neoplasm, sarcoidosis, and other miscellaneous pulmonary diagnoses. Complication rates were low in both groups and not statistically different; yield data were likewise comparable, particularly in diffuse neoplasm and sarcoidosis. This report suggests that TBB without fluoroscopy (in the basilar segments) is safe and that diagnostic yield, particularly in sarcoidosis and diffuse neoplasm, is good. (Chest 1988; 94:557-60)

Section snippets

Study Design

All fiberoptic bronchoscopic examinations performed by pulmonary fellows and staff members between January 1980 and December 1986 were reviewed. Basic patient data were recorded, including age, sex, indication for bronchoscopy, bronchoscopic approach, lobe biopsied, and whether fluoroscopy was used. Records of all patients undergoing biopsy procedures were reviewed, including bronchoscopy reports, radiographic reports, pathology reports, blood bank logs, and physician progress notes. When

RESULTS

A total of 1,232 fiberoptic bronchoscopic procedures were performed during this study period, of which 247 patients underwent TBB. Bronchoscopic reports were available for all of these patients. Inpatient and outpatient records were found and reviewed in 226 cases. Where patient records were sparse, actual postprocedure chest roentgenograms were reviewed in 34 cases and pathology specimen slides in 33 cases; patient and/or physician interviews were conducted in 57 cases. The patients' mean age

DISCUSSION

Since the introduction of the flexible fiberoptic bronchoscope in the 1970s, its utility as a diagnostic tool with the use of TBB has dramatically increased. The use of fluoroscopy during TBB has been a matter of contention for several years, raising the question of safety as well as yield.8, 9 The recent studies of Prigogine and Schmerber,14 also involving diffuse lung disease not limited to sarcoidosis, showed rates of complication similar to those of our series, albeit with smaller numbers

ACKNOWLEDGMENT

We wish to thank Ms. Martha Acosta for her help in preparing the manuscript.

References (0)

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The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.

Manuscript received November 23; revision accepted February 1.

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