Safety of flexible bronchoscopy, rigid bronchoscopy, and endobronchial ultrasound-guided transbronchial needle aspiration in patients with malignant space-occupying brain lesions

Chest. 2015 Jun;147(6):1621-1628. doi: 10.1378/chest.14-1704.

Abstract

Background: Bronchoscopy in patients with space-occupying brain lesions is anecdotally felt to carry a high risk of neurologic complications.

Methods: We conducted a retrospective cohort study of patients with evidence of a malignant, space-occupying brain lesion who were referred for flexible or rigid bronchoscopy or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The primary outcome of interest was the incidence of neurologic complications following the procedures in these patients.

Results: Of the 103 enrolled patients, flexible bronchoscopy was performed in 41, rigid bronchoscopy in 12, and EBUS-TBNA in 50. Among these patients, 41 (40%) had evidence suggestive of increased intracranial pressure on imaging. Among all study patients, none (95% CI, 0-0.035) had neurologic, procedure-specific, or sedation-specific complications, and the level of care was not escalated in any of these patients.

Conclusions: On the basis of our findings, we recommend that procedures such as flexible or rigid bronchoscopy or EBUS-TBNA in patients with malignant space-occupying brain lesions should be considered reasonably safe as long as neurologic findings are stable.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Aged
  • Brain Neoplasms / complications*
  • Brain Neoplasms / pathology
  • Bronchoscopy / adverse effects*
  • Bronchoscopy / instrumentation
  • Bronchoscopy / methods
  • Cohort Studies
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration / adverse effects*
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration / instrumentation
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration / methods
  • Female
  • Humans
  • Incidence
  • Intracranial Pressure / physiology
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / secondary
  • Male
  • Middle Aged
  • Nervous System Diseases / epidemiology*
  • Nervous System Diseases / physiopathology
  • Retrospective Studies
  • Risk Factors