E. Baea (Dr), YS. Parka (Prof), J. Cho*a (Prof)

a Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, KOREA, REPUBLIC OF

* apricot6@seoul.ac.kr

Background: Radial probe endobronchial ultrasound (radial EBUS) is widely used for the diagnosis of pulmonary lesions. However, the diagnostic value of radial EBUS-guided transbronchial lung biopsy varies, and its complications, especially the risk of bleeding, are not well studied. In this study, we evaluated the diagnostic outcomes and complication rate of this procedure and investigated the risk factors associated with procedure-related bleeding events.

Methods: This retrospective study included consecutive patients who underwent radial EBUS-guided transbronchial lung biopsy from December 2019 to June 2022. Radial EBUS was performed under moderate sedation in inpatients and outpatients. The severity of bleeding was graded by the Delphi consensus statement.

Results: Of a total of 127 patients (mean age, 67.6 years; men 59.1%), outpatients accounted for 32.8%. The diagnostic accuracy, sensitivity, and specificity for malignancy were 71.7% (63/113), 66.3% (63/95), and 100% (18/18), respectively. Twenty eight patients (22%) developed complications (pneumothorax, 3; pneumonia 6; complicated pleural effusion, 3; bleeding event grade 2 or higher, 21). Among the 41 outpatients, only 2 patients developed complications (pneumothorax without intervention, 1; grade 2 bleeding event, 1). Of the 21 patients (16.5%) with procedure-related bleeding events, 18 patients had grade 2, and only 3 had grade 3 bleeding complications. In a multivariable analysis, large size of lung lesion over 30mm (adjusted odds ratio (OR) 5.02, P=0.033) and the procedure time of more than 25 minutes (adjusted OR 3.40, P=0.045) were significantly associated with the risk of grade 2 or higher bleeding events. The risk of bleeding was significantly reduced when the lung lesion was located in the distal third of the lung (adjusted OR 0.29, P=0.038).

Conclusion: Radial EBUS-guided transbronchial lung biopsy is the accurate and safe diagnostic method. Procedure-related bleeding event was associated with central location and large size of lung lesion and long duration of the procedure.

Disclosure of funding source(s): none