Avoiding Routine Chest Radiography after Transbronchial Biopsy Is Safe

Area of Science:

• Pulmonology
• Thoracic Surgery
• Diagnostic Imaging

Background:

• Pneumothorax complicates 1-4% of fiberoptic bronchoscopy with transbronchial biopsy (FOB-TBB).
• Routine post-TBB chest radiography (CXR) has a low diagnostic yield but remains common practice.
• Avoiding routine CXR in asymptomatic patients has been suggested.

Purpose of the Study:

• To prospectively evaluate the feasibility and safety of omitting routine post-TBB CXR.
• To determine the incidence and clinical significance of pneumothorax in asymptomatic patients after FOB-TBB.

Main Methods:

• 201 patients undergoing FOB-TBB were prospectively studied.
• Symptom questionnaires (chest pain, dyspnea, cough) were administered pre-procedure, 2-hours post-procedure, and 24-48 hours post-procedure.
• Post-TBB CXR was performed only when clinically indicated by the treating physician.

Main Results:

• Only 8% of patients had CXRs ordered due to suspected pneumothorax.
• Pneumothorax occurred in 3% early (within 2 hours) and 1% late (after 24 hours).
• No clinically significant pneumothoraxes were found in asymptomatic patients without oxygen desaturation.

Conclusions:

• Pneumothorax is rare and typically clinically insignificant in asymptomatic patients post-FOB-TBB.
• Routine post-TBB CXR is not necessary for asymptomatic patients.
• Omitting routine CXR in this patient group is safe and avoids unnecessary imaging.