Predictors of Severe Bleeding During Endobronchial Biopsy: Experience of 537 Cases

Abstract

Background: Endobronchial biopsy (EBB) remains the standard procedure for evaluating endobronchial lesions visualized during flexible bronchoscopy. However, the predictors of bleeding and its impact on the diagnostic yield of EBB remains unknown.

Methods: This was a retrospective study of subjects who underwent EBB for suspected neoplastic endobronchial lesion. We noted the demographic details, radiology, bronchoscopy findings (vascularity and location of the lesion), and the procedural details. Immediately after EBB, the bronchoscopist recorded the severity of bleed as none, mild, moderate, or severe (requiring instillation of cold saline/topical adrenaline or tamponade to control bleed). We assessed the diagnostic yield of EBB, the incidence and predictors of severe bleeding.

Results: A total of 537 subjects with a mean age of 59.7 years (84.2% males) were included. On histopathology, malignancy was confirmed in 429 (85.8%) subjects. Severe bleeding occurred in 45 (8%) subjects. On a multivariate logistic regression analysis, bronchoscopic appearance of increased vascularity [odds ratio (95% confidence interval), 2.68 (1.38-5.19)] and the central location of the tumor [odds ratio (95% confidence interval), 3.01 (1.52-5.96)] were independent predictors of severe bleeding during EBB. Severe bleeding led to significantly lesser median number of biopsies (4 vs. 6, P=0.001) obtained, and a higher proportion of nondiagnostic biopsies (20% vs. 7.1%, P=0.004).

Conclusion: Severe bleeding during EBB was associated with a decrease in the number of biopsies obtained and a lower diagnostic yield. A centrally located and vascular-appearing lesion on bronchoscopy predicted severe bleeding.