Respiratory investigation · 2026
Bleeding risk and diagnostic yield of bronchoscopy in hematologic malignancies: Platelet count as a predictor.
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Yomota Makiko, Hakozaki Taiki, Kato Terufumi, Doki Noriko, Hosomi Yukio
Аннотация
BACKGROUND: Patients with hematologic malignancies frequently require diagnostic bronchoscopy for the evaluation of pulmonary complications, but thrombocytopenia complicates procedural safety and decision-making. We aimed to identify a platelet count threshold associated with increased intraprocedural bleeding risk during bronchoscopy with biopsy or brushing in this population.
METHODS: We conducted a single-centre retrospective cohort study of adults with hematologic malignancies who underwent diagnostic bronchoscopy between 2010 and 2023. Bleeding was graded according to the Nashville Bleeding Scale (grade 1-4). Among procedures including transbronchial lung biopsy (TBLB) and/or endobronchial brushing, receiver operating characteristic (ROC) curve analysis was used to identify the platelet count cut-off associated with grade 2-4 bleeding.
RESULTS: Overall, 122 bronchoscopies were performed in 117 patients; 16 procedures (13.1%) were complicated by grade 2-4 bleeding. Among the 89 procedures involving TBLB and/or brushing, the optimal platelet count cut-off for predicting grade 2-4 bleeding was 8.2 × 104/μL (area under the ROC curve 0.73, 95% CI 0.59-0.88; sensitivity 85.7%; specificity 65.7%). No procedure-related deaths occurred. TBLB yielded a pathological diagnosis in 22.4% (17/76) of procedures, while brushing cytology was diagnostic in 3.6% (2/55). Organizing pneumonia was the most frequent histopathological diagnosis, followed by lung cancer and fungal infection.
CONCLUSIONS: In patients with haematologic malignancies and thrombocytopenia, bronchoscopy with biopsy or brushing provides clinically useful diagnostic information but carries an increased bleeding risk at lower platelet counts. A platelet count of approximately 8.2 × 104/μL may serve as a reference point indicating increased bleeding risk at lower counts during TBLB and brushing, rather than a definitive "safe" threshold. However, given the limited number of bleeding events, this should be regarded as an exploratory finding requiring validation in larger, prospective studies.
METHODS: We conducted a single-centre retrospective cohort study of adults with hematologic malignancies who underwent diagnostic bronchoscopy between 2010 and 2023. Bleeding was graded according to the Nashville Bleeding Scale (grade 1-4). Among procedures including transbronchial lung biopsy (TBLB) and/or endobronchial brushing, receiver operating characteristic (ROC) curve analysis was used to identify the platelet count cut-off associated with grade 2-4 bleeding.
RESULTS: Overall, 122 bronchoscopies were performed in 117 patients; 16 procedures (13.1%) were complicated by grade 2-4 bleeding. Among the 89 procedures involving TBLB and/or brushing, the optimal platelet count cut-off for predicting grade 2-4 bleeding was 8.2 × 104/μL (area under the ROC curve 0.73, 95% CI 0.59-0.88; sensitivity 85.7%; specificity 65.7%). No procedure-related deaths occurred. TBLB yielded a pathological diagnosis in 22.4% (17/76) of procedures, while brushing cytology was diagnostic in 3.6% (2/55). Organizing pneumonia was the most frequent histopathological diagnosis, followed by lung cancer and fungal infection.
CONCLUSIONS: In patients with haematologic malignancies and thrombocytopenia, bronchoscopy with biopsy or brushing provides clinically useful diagnostic information but carries an increased bleeding risk at lower platelet counts. A platelet count of approximately 8.2 × 104/μL may serve as a reference point indicating increased bleeding risk at lower counts during TBLB and brushing, rather than a definitive "safe" threshold. However, given the limited number of bleeding events, this should be regarded as an exploratory finding requiring validation in larger, prospective studies.