Safety of flexible bronchoscopy, rigid bronchoscopy, and endobronchial ultrasound-guided transbronchial needle aspiration in patients with malignant space-occupying brain lesions.
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.
Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center. Electronic address: hbgrosu@mdanderson.org.
Horiana B
HB
Grosu
Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center.
Rodolfo C
RC
Morice
Department of Anesthesiology, The University of Texas MD Anderson Cancer Center.
Mona
M
Sarkiss
Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center.
Lara
L
Bashoura
Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center.
George A
GA
Eapen
Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center.
Carlos A
CA
Jimenez
Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center.
Saadia
S
Faiz
Department of Pulmonary Medicine, Baylor College of Medicine.
Donald R
DR
Lazarus
Department of Pulmonary Medicine, Michael DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX.
Roberto F
RF
Casal
Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center.
David E
DE
Ost
D000368:Aged; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology; D001999:Bronchoscopy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D015331:Cohort Studies; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007427:Intracranial Pressure / Q000502:physiology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors