Pneumothorax After Transbronchial Biopsy in Pulmonary Fibrosis: Lessons from the Multicenter COMET Trial

Abstract

Purpose Some patients with diffuse interstitial lung disease (ILD) undergo bronchoscopy with transbronchial biopsy (TBB) as part of their diagnostic evaluation. It is unclear what the incidence and risk factors for pneumothorax (PTX) following TBB are in this patient population. Methods Ninety-seven subjects with pulmonary fibrosis who underwent a research bronchoscopy with TBB as part of the multicenter Correlating Outcomes with Biochemical Markers to Estimate Time-progression in Idiopathic Pulmonary Fibrosis (COMET) trial were retrospectively reviewed. We compared subjects who developed a PTX during research bronchoscopy with TBB versus those who did not. Results Seven patients (7.2%) experienced a PTX during research bronchoscopy with TBB. Subjects who experienced PTX during TBB had significantly lower DLCO percent predicted (29 ± 8 versus 45 ± 15, P=0.006) and had lower resting room air saturation of peripheral oxygen (SPO2) on 6-minute walk testing (91±10 versus 95±3, P=0.02). No differences between groups were found with respect to age, gender, race, BMI, HRCT characteristics, or number of transbronchial biopsies performed. Conclusion The incidence of PTX following research bronchoscopy with TBB in patients with pulmonary fibrosis was found to be 7.2% in this study. Patients who developed a pneumothorax had greater impairments in gas exchange at baseline evidenced by a lower DLCO % predicted and a lower resting room air SPO2 when compared to subjects without PTX as a complication.

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

“…In our study, the incidence of PTX was 6.16% which is comparable to the data from the BTS guideline (PTX incidence reported to be 1–6%) [3], the Sindhwani et al study (10.2%) [8], from the COMET Trial (7.2%) [9] and from the Ibrahim et al study (9.8%) [10]. Our cohort included 48% of patients with nodular lesions and there was an insignificant trend towards more nodular lesions TBB in the PTX group.…”

“…Indeed, compared to patients without PTX, in patients with PTX there was also an insignificant trend towards more pulmonary emphysema in our cohort. The ideal number of TBB samples that should be taken at each procedure remains controversial, some authors concluded that it has no relevance to risk of post-procedural PTX [9]. In our analysis, the number of samples taken during TBB was significantly associated with PTX development and remained a significant factor of PTX development also in the logistic regression analysis.…”

“…Our cohort included 48% of patients with nodular lesions and there was an insignificant trend towards more nodular lesions TBB in the PTX group. Nodular lesions are strongly associated with the presence of pulmonary emphysema and vice versa [11], which may increase the risk of postprocedural PTX development [9, 12]. Indeed, compared to patients without PTX, in patients with PTX there was also an insignificant trend towards more pulmonary emphysema in our cohort.…”

Meta-analysis of the radiological and clinical features of Usual Interstitial Pneumonia (UIP) and Nonspecific Interstitial Pneumonia (NSIP)

“…By achieving a reliable diagnosis based on imaging features, patients potentially avoid the risks of bleeding and general anesthesia and the high costs associated with a surgical biopsy [13][14][15][16]. Although UIP and NSIP imaging features have been described extensively in the literature and were incorporated in the diagnostic guidelines, no systematic review of the literature has been conducted.…”

Secondary spontaneous pneumothorax in idiopathic pulmonary fibrosis: Grim news

“…in this issue highlights the clinical relevance of another well known, but poorly reported complication of IPF, namely the appearance of a secondary spontaneous pneumothorax (SSP) . Needless to say, pneumothorax in this population may also follow a transbronchial lung biopsy (incidence of 7.2% in a recent study), but data regarding the prognostic influence of iatrogenic pneumothorax on IPF outcome are lacking. The pathogenesis of SSP in the context of IPF is uncertain.…”