The bleeding risk and safety of repeated bronchoscopies with tissue sampling in patients with pulmonary lesions

ABSTRACT

Background

Many patients need repeated bronchoscopies with tissue sampling to obtain the final pathological results and guide the optimal subsequent treatment of pulmonary lesions. However, few studies have explored the safety of repeated biopsies.

Methods

The records of patients who underwent bronchoscopy-guided tissue sampling because of pulmonary lesions at the respiratory department between 1 January 2008 and 31 December 2019 were revised. The patients’ clinical characteristics, information about bronchoscopy and incidence of complications were collected and analyzed.

Results

In total, 3899 bronchoscopy-guided tissue sampling procedures were conducted in the 1781 participants. There was no significant difference in the incidence of major complications between the initial bronchoscopies and repeated bronchoscopies (1.12% vs. 1.13%, χ² < 0.01, df = 1, p = 0.98), as was the incidence of hemoptysis (χ² = 2.18, df = 1, p = 0.14). However, the bleeding rate of patients who experienced bleeding during the first bronchoscopies was significantly higher than that of patients who did not experience bleeding (61.19% vs. 32.63%, χ² = 253.00, df = 1, p < 0.01).

Conclusions

For patients with pulmonary lesions, re-bronchoscopy with tissue sampling appears to infer the same risk of bleeding including severe bleeding as experienced during the initial bronchoscopy. However, it should be treated with discretion when performing repeated tissue sampling on patients who once bled.

KEYWORDS:

• Repeated tissue sampling
• bronchoscope
• pulmonary lesions
• complication
• bleeding risk

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethics approval and consent to participate

The procedures of this study were approved by the Regional Ethics Committee of the Second Affiliated Hospital (Tangdu Hospital) of Air Force Medical University and were carried out in accordance with the approved protocol. The committee waived the requirement for patient informed consent because of the retrospective nature of the study.

Consent for publication

All authors have read and approved the final manuscript.

Data availability

The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.

Abbreviations

EBUS-GS: endobronchial ultrasonography with a guide sheath;

VBN: virtual bronchoscopic navigation;

ENB: electromagnetic navigation bronchoscopy;

NSCLC: non-small cell lung cancer;

ICU: intensive care unit;

EGFR: epidermal growth factor receptor;

ALK: anaplastic lymphoma kinase;

ROS1: ROS proto-oncogene 1;

BRAF: B-Raf protooncogene;

PD-L1: programmed cell death ligand 1.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17476348.2022.2159382

Additional information

Funding

The research was funded by the Liaoning Provincial Doctoral Research Fund (2020-BS-033) and China Postdoctoral Science Foundation (2019M653911). These funds help us with data collection and analysis.