Home
|
Inbox
|
Search
|
View Abstract
Utility of Transbronchial Biopsy in Management Decisions Among Immunocompromised Patients with Pulmonary Processes
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A5017 - Utility of Transbronchial Biopsy in Management Decisions Among Immunocompromised Patients with Pulmonary Processes
Author Block: M. H. Bourne, E. S. Edell; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States.
Rationale: Immunocompromised patients with acute and sub-acute pulmonary processes often undergo bronchoscopy as part of their diagnostic evaluation. Transbronchial biopsies are frequently used in conjunction with bronchoalveolar lavage (BAL), airway inspection, and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Performing transbronchial biopsy adds significant risk with questionable yield. There are limited studies evaluating the utility of transbronchial biopsy in immunocompromised patients with pulmonary processes. We aimed to assess how often the transbronchial biopsy added information that changed the management in this patient population.
Methods: We surveyed all bronchoscopies in our practice database from 2015 and 2016. We identified 68 immunocompromised patients based on physician report who underwent bronchoscopy with both BAL-immunocompromised host protocol (BAL-ICH) which includes cell count, cytology, and an extended infectious workup who also had transbronchial biopsy. Lung transplant recipients were excluded. Rationale for the procedure was obtained from the medical record prior to the bronchoscopy. The results of the BAL-ICH and transbronchial biopsy were compared. Subsequent management decisions were obtained from review of the medical record. We identified all changes in management including changes in immunosuppressive agents, antibiotics, chemotherapy, goals of care, and decisions on further evaluation and procedures. We aimed to document whether the transbronchial biopsy added information not identified with the BAL-ICH that justified a change in management.
Results: Of 68 bronchoscopic procedures performed on immunocompromised patients with acute and sub-acute pulmonary processes, management decisions solely based on the results of the transbronchial biopsy apart from findings in the BAL-ICH, EBUS-TBNA, or inspection occurred 34% of the time (23/68). Subgroup analysis revealed that those immunocompromised due to solid tumors and associated treatments had their management changed 85% (11/13) of the time based solely on the results of the transbronchial biopsy. The most frequent change made was the addition of steroids for organizing pneumonia.
Conclusions: Transbronchial biopsy remains an important diagnostic modality and frequently adds additional information in addition to BAL, EBUS-TBNA, and inspection in immunocompromised patients. Transbronchial biopsy may be higher yield in certain subgroups of immunocompromised patients. These potential benefits must be weighed against the risks inherent to the procedure.
Author Block: M. H. Bourne, E. S. Edell; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States.
Rationale: Immunocompromised patients with acute and sub-acute pulmonary processes often undergo bronchoscopy as part of their diagnostic evaluation. Transbronchial biopsies are frequently used in conjunction with bronchoalveolar lavage (BAL), airway inspection, and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Performing transbronchial biopsy adds significant risk with questionable yield. There are limited studies evaluating the utility of transbronchial biopsy in immunocompromised patients with pulmonary processes. We aimed to assess how often the transbronchial biopsy added information that changed the management in this patient population.
Methods: We surveyed all bronchoscopies in our practice database from 2015 and 2016. We identified 68 immunocompromised patients based on physician report who underwent bronchoscopy with both BAL-immunocompromised host protocol (BAL-ICH) which includes cell count, cytology, and an extended infectious workup who also had transbronchial biopsy. Lung transplant recipients were excluded. Rationale for the procedure was obtained from the medical record prior to the bronchoscopy. The results of the BAL-ICH and transbronchial biopsy were compared. Subsequent management decisions were obtained from review of the medical record. We identified all changes in management including changes in immunosuppressive agents, antibiotics, chemotherapy, goals of care, and decisions on further evaluation and procedures. We aimed to document whether the transbronchial biopsy added information not identified with the BAL-ICH that justified a change in management.
Results: Of 68 bronchoscopic procedures performed on immunocompromised patients with acute and sub-acute pulmonary processes, management decisions solely based on the results of the transbronchial biopsy apart from findings in the BAL-ICH, EBUS-TBNA, or inspection occurred 34% of the time (23/68). Subgroup analysis revealed that those immunocompromised due to solid tumors and associated treatments had their management changed 85% (11/13) of the time based solely on the results of the transbronchial biopsy. The most frequent change made was the addition of steroids for organizing pneumonia.
Conclusions: Transbronchial biopsy remains an important diagnostic modality and frequently adds additional information in addition to BAL, EBUS-TBNA, and inspection in immunocompromised patients. Transbronchial biopsy may be higher yield in certain subgroups of immunocompromised patients. These potential benefits must be weighed against the risks inherent to the procedure.
|
Home
|
Inbox
|
Search
|