title: Avoiding Routine Chest Radiography after Transbronchial Biopsy Is Safe.
abstract: BACKGROUND
  Fiberoptic bronchoscopy (FOB) with transbronchial biopsy (TBB) is complicated by a pneumothorax in 1-4% of cases. Performance of routine post-TBB chest radiography (CXR) results in an extremely low diagnostic yield but nevertheless is the common clinical practice prevailing today. It has previously been suggested that routine post-TBB CXR could be avoided in asymptomatic patients.
  
  
  OBJECTIVE
  The objective of this study was to prospectively assess the feasibility and safety of this approach.
  
  
  METHODS
  The study group included 201 consecutive patients who underwent FOB with TBB at our institution between January 2009 and September 2014. All subjects completed a preprocedural, a 2-hour postprocedural, and a 24- to 48-hour postprocedural symptom questionnaire (chest pain, dyspnea, and cough). Post-TBB CXR was ordered by the treating physician only if indicated. All cases of pneumothorax were documented. Additionally, the following information was recorded: sex, age, immune status, indication for FOB, total number of biopsies done, lobe sampled, and pulse oxygen saturation.
  
  
  RESULTS
  Sixteen CXRs were ordered by the treating physician due to suspected pneumothorax (8%). Early-onset pneumothorax (i.e. within 2 h of TBB) was diagnosed radiologically in 6 patients (3%). Two late-onset pneumothoraxes (1%) were diagnosed more than 24 h after TBB. No pneumothoraxes of clinical significance were diagnosed among asymptomatic patients without significant oxygen desaturation events.
  
  
  CONCLUSIONS
  Among asymptomatic patients without significant desaturation events, pneumothorax is rare and usually of negligible clinical significance. Therefore, performance of routine CXR after TBB is not necessary and can be safely avoided in this category of patients.
authors: Pulmonary Institute, Shaare Zedek Medical Center, Jerusalem, Israel.
authors: Gabriel
authors: G
authors: Izbicki
authors: Ayal
authors: A
authors: Romem
authors: Nissim
authors: N
authors: Arish
authors: Clement
authors: C
authors: Cahan
authors: Hava
authors: H
authors: Azulai
authors: Chen
authors: C
authors: Chen-Shuali
authors: Esther
authors: E
authors: Tennenhaus
authors: Zipi
authors: Z
authors: Bar-Yosef
authors: Evgeniya
authors: E
authors: Zlotkevich
authors: Ariel
authors: A
authors: Rokach
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D001706:Biopsy / Q000009:adverse effects*; D001999:Bronchoscopy / Q000009:adverse effects*; D002637:Chest Pain / Q000453:epidemiology / Q000209:etiology; D003371:Cough / Q000453:epidemiology / Q000209:etiology; D004417:Dyspnea / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D013902:Radiography, Thoracic; D011795:Surveys and Questionnaires