Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: Results of the AQuIRE registry.

BACKGROUND Few studies of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA) have been large enough to identify risk factors for complications. The primary objective of this study was to quantify the incidence of and risk factors for complications in patients undergoing EBUS-TBNA. METHODS Data on prospectively enrolled patients undergoing EBUS-TBNA in the American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education (AQuIRE)database were extracted and analyzed for the incidence, consequences, and predictors of complications. RESULTS We enrolled 1,317 patients at six hospitals. Complications occurred in 19 patients (1.44%;95% CI, 0.87%-2.24%). Transbronchial lung biopsy (TBBx) was the only risk factor for complications,which occurred in 3.21% of patients who underwent the procedure and in 1.15% of those who did not (OR, 2.85; 95% CI, 1.07-7.59; P 5 .04). Pneumothorax occurred in seven patients(0.53%; 95% CI, 0.21%-1.09%). Escalations in level of care occurred in 14 patients (1.06%;95% CI, 0.58%-1.78%); its risk factors were age . 70 years (OR, 4.06; 95% CI, 1.36-12.12; P 5 .012),inpatient status (OR, 4.93; 95% CI, 1.30-18.74; P 5 .019), and undergoing deep sedation or general anesthesia (OR, 4.68; 95% CI, 1.02-21.61; P 5 .048). TBBx was performed in only 12.6% of patients when rapid on site cytologic evaluation (ROSE ) was used and in 19.1% when it was not used ( P 5 .006).Interhospital variation in TBBx use when ROSE was used was significant ( P , .001). CONCLUSIONS TBBx was the only risk factor for complications during EBUS-TBNA procedures.ROSE significantly reduced the use of TBBx.

[1]  P. Suratt,et al.  Deaths and complications associated with transbronchial lung biopsy. , 2015, The American review of respiratory disease.

[2]  O. Nanni,et al.  EBUS‐TBNA in mediastinal/hilar lymphadenopathies and/or masses: an Italian case series , 2012, The clinical respiratory journal.

[3]  G. da Cunha Santos,et al.  A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. , 2011, The Journal of thoracic and cardiovascular surgery.

[4]  D. Feller-Kopman,et al.  Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE Bronchoscopy Registry. , 2011, Chest.

[5]  M. Wahidi,et al.  American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients. , 2011, Chest.

[6]  Haruhiko Nakamura,et al.  [A case of acute mediastinitis after endobronchial needle aspiration]. , 2011, Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society.

[7]  Chun-Ta Huang,et al.  A rare constellation of empyema, lung abscess, and mediastinal abscess as a complication of endobronchial ultrasound-guided transbronchial needle aspiration. , 2011, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[8]  M. Sarkiss.  Anesthesia for bronchoscopy and interventional pulmonology: from moderate sedation to jet ventilation , 2011, Current opinion in pulmonary medicine.

[9]  M. Falzon,et al.  Combination of endobronchial ultrasound‐guided transbronchial needle aspiration with standard bronchoscopic techniques for the diagnosis of stage I and stage II pulmonary sarcoidosis , 2011, Respirology.

[10]  L. Yarmus,et al.  A Randomized Prospective Trial of the Utility of Rapid On-Site Evaluation of Transbronchial Needle Aspirate Specimens , 2011, Journal of bronchology & interventional pulmonology.

[11]  C. Dooms,et al.  Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. , 2010, JAMA.

[12]  G. Michaud,et al.  A multicenter, prospective, advanced diagnostic bronchoscopy outcomes registry. , 2010, Chest.

[13]  S. Moffatt-Bruce,et al.  Mediastinal abscess after endobronchial ultrasound with transbronchial needle aspiration: a case report , 2010, Journal of cardiothoracic surgery.

[14]  M. Block.  Endobronchial ultrasound for lung cancer staging: how many stations should be sampled? , 2010, The Annals of thoracic surgery.

[15]  A. Tremblay,et al.  A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis. , 2009, Chest.

[16]  P. Shah,et al.  Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis , 2009, Thorax.

[17]  B. Han,et al.  Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis. , 2009, European journal of cancer.

[18]  F. Herth,et al.  Prospective risk-adjusted morbidity and mortality outcome analysis after therapeutic bronchoscopic procedures: results of a multi-institutional outcomes database. , 2008, Chest.

[19]  A. Fein,et al.  A randomized trial of CT fluoroscopic-guided bronchoscopy vs conventional bronchoscopy in patients with suspected lung cancer. , 2008, Chest.

[20]  I. Yoshino,et al.  Role of endobronchial ultrasound-guided transbronchial needle aspiration in the management of lung cancer , 2008, General thoracic and cardiovascular surgery.

[21]  F. Herth,et al.  Diagnosis of Mediastinal Adenopathy—Real-Time Endobronchial Ultrasound Guided Needle Aspiration versus Mediastinoscopy , 2008, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[22]  R. Morice,et al.  Clinical implications of granulomatous inflammation detected by endobronchial ultrasound transbronchial needle aspiration in patients with suspected cancer recurrence in the mediastinum , 2008, Journal of cardiothoracic surgery.

[23]  M. Wallace,et al.  Minimally invasive endoscopic staging of suspected lung cancer. , 2008, JAMA.

[24]  R. Morice,et al.  Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lymphoma , 2007, Thorax.

[25]  W Michael Alberts,et al.  Diagnosis and management of lung cancer executive summary: ACCP evidence-based clinical practice guidelines (2nd Edition). , 2007, Chest.

[26]  Michael K Gould,et al.  Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). , 2007, Chest.

[27]  Michael Wallace,et al.  Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). , 2007, Chest.

[28]  R. Morice,et al.  Is endobronchial ultrasound additive to routine bronchoscopy in diagnosing sarcoidosis? , 2007, European Respiratory Journal.

[29]  D. Ost,et al.  Advances in bronchoscopic diagnosis of lung cancer , 2007, Current opinion in pulmonary medicine.

[30]  F. Herth,et al.  Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis , 2007, European Respiratory Journal.

[31]  Takehiko Fujisawa,et al.  Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. , 2005, Lung cancer.

[32]  K. Rabe,et al.  Endoscopic ultrasound added to mediastinoscopy for preoperative staging of patients with lung cancer. , 2005, JAMA.

[33]  D. Baram,et al.  Impact of rapid on-site cytologic evaluation during transbronchial needle aspiration. , 2005, Chest.

[34]  M. Louw,et al.  Utility of Rapid On-Site Evaluation of Transbronchial Needle Aspirates , 2005, Respiration.

[35]  R. Trisolini,et al.  Conventional vs endobronchial ultrasound-guided transbronchial needle aspiration of the mediastinum. , 2004, Chest.

[36]  J. Jamart,et al.  Combined bronchoalveolar lavage and transbronchial lung biopsy: safety and yield in ventilated patients , 2003, European Respiratory Journal.

[37]  Michael A. Brooks,et al.  Transbronchial needle aspiration in diagnosing and staging lung cancer: how many aspirates are needed? , 2002, American journal of respiratory and critical care medicine.

[38]  D. Ost,et al.  Evaluation and management of the solitary pulmonary nodule. , 2000, American journal of respiratory and critical care medicine.

[39]  H. Rubin,et al.  Utility of on-site cytopathology assessment for bronchoscopic evaluation of lung masses and adenopathy. , 2000, Chest.

[40]  M. Kollef,et al.  Safety and yield of transbronchial biopsy in mechanically ventilated patients. , 1997, Critical care medicine.

[41]  M. Pasque,et al.  The role of transbronchial lung biopsy in the treatment of lung transplant recipients. An analysis of 200 consecutive procedures. , 1992, Chest.

[42]  V. Garrido,et al.  Safety of the Transbronchial Biopsy in Outpatients , 1991 .

[43]  R. Davenport.  Rapid on-site evaluation of transbronchial aspirates. , 1990, Chest.

[44]  A. Donabedian,et al.  The quality of care. How can it be assessed? , 1988, JAMA.

[45]  D. Zavala.  Pulmonary hemorrhage in fiberoptic transbronchial biopsy. , 1976, Chest.

[46]  Hojoong Kim,et al.  The role of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal and hilar lymph node metastases in patients with extrapulmonary malignancy. , 2011, Internal medicine.

[47]  M. Jantz.  The old and the new of sedation for bronchoscopy. , 2009, Chest.

[48]  M. Wahidi,et al.  A phase 3, randomized, double-blind study to assess the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy. , 2009, Chest.

[49]  F. Herth,et al.  Conventional vs endobronchial ultrasound-guided transbronchial needle aspiration: a randomized trial. , 2004, Chest.