Abstract
Objective
To assess how often transbronchial biopsy (TBBx) added unique positive findings apart
from other synchronous bronchoscopic sampling techniques including the bronchoalveolar
lavage–immunocompromised host (BAL-ICH) panel that justified changes in management
in an array of immunocompromised patients with new pulmonary radiographic abnormalities.
Methods
We retrospectively reviewed all bronchoscopies performed at Mayo Clinic Rochester
between January 2012 and December 2017; on the basis of the physician’s selection
of a BAL-ICH panel, we identified 192 immunocompromised patients who underwent bronchoscopy
with both a BAL-ICH panel and TBBx. The results of the BAL-ICH panel and TBBx were
compared and subsequent management decisions analyzed from clinical notes. We identified
changes in immunosuppressive agents, antibiotics, chemotherapy, goals of care, and
decisions on further evaluation and procedures. We assessed whether the TBBx findings
added information not identified on the BAL-ICH panel and other bronchoscopic sampling
methods performed during the same procedure that justified subsequent management changes.
Results
Of 192 bronchoscopic procedures performed on immunocompromised patients with acute
and subacute pulmonary radiographic abnormalities, management changes justified by
the unique positive results of the TBBx occurred 28% (51/192) of the time. Those immunocompromised
by solid malignant neoplasms and receiving active immunosuppressive therapy had management
changes justified 62.1% (18/29) of the time by the TBBx results. No additional fungal
organisms were identified on TBBx that were accounted for on the BAL-ICH panel.
Conclusion
Transbronchial biopsy may add information to other bronchoscopic findings in immunocompromised
patients, especially those with solid malignant neoplasms receiving active immunosuppressive
treatment. These potential benefits must be weighed against the risks inherent to
the procedure.
Abbreviations and Acronyms:
BAL (bronchoalveolar lavage), BAL-ICH (bronchoalveolar lavage–immunocompromised host panel), EBUS-TBNA (endobronchial ultrasound-guided transbronchial needle aspiration), HSCT (hematopoietic stem cell transplant), ICH (immunocompromised host), PCR (polymerase chain reaction), TBBx (transbronchial biopsy)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: May 03, 2021
Footnotes
Potential Competing Interests: The authors report no competing interests.
Identification
Copyright
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