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Vol. 34. Issue 3.
Pages 133-141 (March 1998)
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Vol. 34. Issue 3.
Pages 133-141 (March 1998)
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Factores relacionados con la rentabilidad diagnóstica y aparición de complicaciones de la biopsia transbronquial
Factors related to diagnostic yield and complications of transbronchial biopsy
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J. Hernández Borge*, I. Alfageme Michavila, J. Muñoz Méndez, R. Villagómez Cerrato, F. Campos Rodríguez, N. Peña Griñán
Sección de Neumología. Hospital Universitario de Valme. Sevilla
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El objetivo de este estudio ha sido estudiar la rentabilidad diagnóstica (RD) de la biopsia transbronquial (BTB) en neumopatías de diversa etiología, así como los diversos factores implicados en la misma y en la aparición de complicaciones durante la técnica.

Es un estudio retrospectivo de una serie de 172 pacientes (98 varones y 74 mujeres) en los que se practicó BTB. En función de la RD y el diagnóstico definitivo se analizaron diversas variables clínicas, patrón radiológico, de TAC y factores técnicos asociados a la BTB. Se recogieron las principales complicaciones, estudiando los posibles mecanismos implicados en su aparición.

Los resultados de la BTB se incluyeron en las siguientes categorías: a) BTB diagnóstica (42,8%); b) BTB inespecífica (21,1%); c) ausencia de parénquima (9,7%); d) parénquima normal (23,4%), y e) error diagnóstico (2,9%). La RD global fue del 43,6%, aunque se elevó al 52% cuando se excluyeron las BTB con ausencia de parénquima y aquellos diagnósticos definitivos que no correspondieron a neumopatías infiltrativas como tales. Los principales diagnósticos definitivos encontrados fueron: infecciones (23,4%), neoplasias (19,4%), sarcoidosis (14,2%), fibrosis pulmonar idiopática (FPI) (17,7%) y otros procesos (23,4%). Existieron diferencias significativas en la edad, sexo, tiempo de evolución previo a la BTB, patrones radiográficos y de TAC en función del diagnóstico definitivo. La aparición de complicaciones y neumotorax fue más frecuente en la FPI, neoplasias e infecciones aunque sin diferencia significativa.

La RD estuvo fundamentalmente determinada por el diagnóstico definitivo, oscilando entre el 60% de la sarcoidosis y el 24% de la FPI (p<0,05). Si que influyera la edad, el sexo, la presencia de inmunosupresión, el número de BTB o la tolerancia de la exploración. Sin embargo, la RD fue superior en los casos sin pérdida de volumen radiográfica (56,3% frente a 37,5%) y con ausencia de patrón en panal en la TAC (44,7 frente a 27,3%). También el tipo de opacidades influyó en la RD (un 53,4% en el vidrio deslustrado frente a 26,7% en los patrones lineales), así como la distribución de las lesiones (un 8,4% en patrones periféricos frente al 48,3% de los difusos o el 50% de los peribroncovascu-lares). El lugar de la BTB fue el único factor que mostró claras diferencias significativas respecto a la RD (el 100% en el lóbulo medio frente al 29,5% en los lóbulos superiores). La tolerancia fue peor en los sujetos de más edad (63,5±10 frente a 52,2±17 años) y con mayores alteraciones funcionales (%FEV1:48,2±6,8 frente a 70,2±17,1). La mala tolerancia de la exploración se asoció a la aparición de complicaciones (el 16,6 frente al 6,3%) y neumotorax (el 25 frente al 6,8%).

La RD de la BTB estuvo principalmente influida por el tipo de proceso estudiado. Las distintas técnicas de imagen parecen fundamentales a la hora de establecer un diagnóstico de presunción y grado de evolución de una patología determinada. Estos datos podrían predecir la rentabilidad de la técnica en un caso determinado. En nuestra serie, la tolerancia de la prueba fue un marcador fiable de la aparición de complicaciones y neumotorax posterior.

Palabras clave:
Biopsia transbronquial
Rentabilidad diagnóstica
Tolerancia
Complicaciones

To study the diagnostic yield of transbronchial biopsy (TBB) in lung diseases of different ethiology, as well as to examine several factors implicated in diagnostic yield and complications of TBB.

Retrospective study of a series of 172 patients (98 women and 74 men) undergoing TBB. Clinical variables, x-ray and CT patterns and technical factors related to TBB were analyzed in relation to diagnostic yield and definitivo diagnosis. We recorded the main complications and studied the possible mechanisms implicated in their appearance.

The results of TBB were classifíed as follows: 1) diagnostic TBB (42.8%); 2) nonspecific TBB (21.1%); absence of parenchyma (NP) (9.7%); 4) normal parenchyma (23.4%); 5) incorrect diagnosis (2.9%). Overall yield was 43.6% but rose to 52% when NP and no infíltrative pneumopathies were excluded. The main findings were infections (23.4%), neoplasms (19.4%), sarcoidosis (14.2%), idiopathic pulmonary fíbrosis (IPF) (17.7%); and other (23.4%). Signifícant differences in diagnosis were found for age, sex, time of evolution prior to TBB, and x-ray and CT patterns. Complications and pneumothorax appeared more frequently in IPF, neoplasms and infections, although the differences were non significant.

Diagnostic value depended mainly on type of disease and ranged from 60% for sarcoidosis to 24% for IPF (p<0.05), with no differences related to age, sex, presence of immuno-suppression, number of TBB or tolerance to exploration. Yield was higher, however, for patients with no loss of radiographic pumonary volume (56.3% versus 37.5%) and with absence of a CT reticular pattern (44.7% versus 27.3%). Type of opacites also influenced yield (53.4% for ground glass versus 26.7% for reticular patterns), as did distribution of lesions (8.4% for peripheral patterns versus 48.3% for diffuse patterns and 50% for peribronchio-vascular patterns). The site of TBB was the only factor showing clearly significant differences in yield (100% in mild lobe versus 29.5% in upper lobes). Tolerance was poorer in older patients (63.5±10 versus 52.2±17 years) and with greater function abnormalities (%FEV1: 48.2±16.8 versus 70.2±17.1). Poor tolerance of exploration was associated with the appearance of complications (16.6% vs 6.3) and pneumothorax (25% versus 6.8%).

The diagnositc yield of TBB was mainly influenced by the type of disease studied. The various imaging techniques were fundamental for establishing preliminary diagnoses and degree of evolution of a specific cases. In our series, tolerance of the technique was a reliable predictor of complications and the presence of post-biops pneumothorax.

Key words:
Transbronchial biopsy
Diagnostic yield
Tolerance
Complications
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