TRANSBRONCHIAL LUNG-BIOPSY THROUGH THE FIBER OPTIC BRONCHOSCOPE - RESULTS AND COMPLICATIONS IN 452 EXAMINATIONS

During 1986-1989, diagnostic fibre optic bronchoscopy (FOB) was perfor med in local anaesthesia in 1144 consecutive patients. Of these, 405 ( 35%) patients, median age 59 years, had transbronchial lung biopsy (TB B) performed under fluoroscopic guidance; 47 patients had a rebronchos copy, i.e. in total 452 FOB were evaluated. The indication for TBB was localized pulmonary lesions in 279 (69%) patients, and diffuse pulmon ary lesions in 126 (31%) patients. Localized lesions: TBB yielded a cl inically relevant diagnosis in 55.2% of the patients. Of the 110 patie nts with malignancy, the overall diagnostic strength was 45.5%. Of the 159 patients with non-malignant lesions, 65.4% were diagnosed by TBB. The diagnostic yield increased with the number of biopsy specimens (l ess than or equal to 4 biopsies, 52%; >4 biopsies, 70%, P<0.05). In 15 5 patients with well defined, circumscribed lesions, the diagnostic yi eld of TBB increased with the size of the lesion (<31 mm, 47%; 31-60 m m, 54%; >60 mm, 60%, P=0.09), and decreased with the distance of the l esion from the main carina (<61 mm, 70%; 61-100 mm, 52%; > 100 mm, 40% P<0.02). Diffuse lesions: TBB yielded a clinically relevant diagnosis in 66.7% of the patients. Of the 15 patients with malignancy, 73.3% w ere diagnosed by TBB. Of the 93 patients with non-malignant lesions, 7 8.5% were diagnosed by TBB. The diagnostic yield showed a trend to inc rease with the number of biopsy specimens (less than or equal to 4 bio psies, 65%; >4 biopsies, 71%, P=0.11). Complications: related to TBB w ere observed in 6% of the FOB; in 5.8% of the procedures a pneumothora x developed, and in 3.8% a chest tube was needed. Major bleeding was o bserved in 0.2% of the procedures. There was no relationship between t he number of TBB and the complication rate, and there was no mortality .