Diagnostic yield of fiberoptic bronchoscopy-guided bronchial biopsies for suspected lung cancer in intensive care unit: A 10-year retrospective study

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Background Fiberoptic bronchoscopy (FOB)-guided bronchial biopsies are the first-line investigation for suspected lung cancer. Their relevance has not been studied for the exploration of an unknown thoracic abnormality diagnosed on admission to the intensive care unit (ICU). Hence, we aimed at determining the diagnostic yield, safety, and therapeutic impact of FOB-guided bronchial biopsies performed in critically ill patients suspected of lung cancer on ICU admission. Methods We conducted a 10-year monocenter retrospective observational study between January 2013 and December 2022. Using the database of the local Pathology Department, we identified 92 patients who underwent FOB-guided bronchial biopsies in the ICU, and finally included 70 patients who underwent this procedure for a thoracic abnormality suspected of neoplasia at ICU admission. The primary endpoint was the diagnostic yield of FOB-guided bronchial biopsies performed in the ICU. Results Lung cancer was clinically suspected on mediastinal and/or hilar involvement, mainly masses ( n =49; 70.0%). FOB was performed with local anesthesia combined with a remifentanil target-controlled infusion ( n =43; 61.4%) associated with standard oxygen therapy ( n =34; 48.6%), or general anesthesia ( n =26; 37.1%). Pathological findings following FOB-guided bronchial biopsies led to a diagnosis in 41 patients (58.6%). The presence of a mass on the admission chest computed tomography scan (odds ratio [OR]=5.13, 95% confidence interval [CI]: 1.35–19.4) or an endobronchial growth or mucosal infiltration visualized during FOB (OR=4.22; 95% CI: 1.22–14.5) were associated with high diagnostic yield. Complications occurred in seven patients (10.0%), within 24 h after the FOB procedure. No death was associated with the procedure. ICU and 1-year mortality rates were 27.1% and 60.0%, respectively. Conclusion FOB-guided bronchial biopsies in the ICU for suspected lung cancer led to the diagnosis in most patients. The safety of the procedure and its potential therapeutical impact should stimulate intensivists to pursue diagnostic investigations for suspected lung cancer in the ICU.