Abstract Introduction Lung cancer remains the leading cause of cancer-related death worldwide, and rising detection of pulmonary nodules has led to more bronchoscopic biopsies. Occasionally, transbronchial lung biopsy (TBLB) yields organizing pneumonia (OP), but its ability to rule out malignancy remains unclear. This study investigates the impact of OP findings during TBLB on future cancer outcomes to improve diagnostic accuracy and patient care. Methods This is a retrospective analysis of 355 lung biopsy reports which were collected from the Indiana University database between January 2010 and January 2023. Patients who underwent fine-needle aspiration, wedge biopsy, or had graft-related pathology were excluded. Seventy-three TBLB were selected, chart reviewed, and further subclassified based on chest computed tomography (CT) findings. Of these, 40 with focal findings including mass, nodules, or lobal infiltrates which were concerning for lung cancer were included, and 33 with diffuse bilateral lung opacities were excluded. Demographic data, lobar involvement, histologic and radiographic findings, and outcomes for at least two years were analyzed. Results Among the 40 patients included, the mean age at biopsy was 58.5 years (median 63), with most being male (n = 25, 62.5%) and White (n = 37, 92.5%). Histologic review showed benign findings consistent with OP alone in 19 cases (47.5%), OP with carcinoma in 1 case (2.5%), and OP with other histologic findings in 20 cases (50%). While all lung lobes were sampled, the right upper lobe was the most frequent biopsy site. At last follow-up, 20 patients (50%) had died (mean time to death: 3.13 years; median: 1.15 years), 10 were alive, and 10 were lost to follow-up. Notably, one patient was later diagnosed with high-grade sarcoma via CT-guided biopsy, another with stage T2bN0M0 adenocarcinoma via surgical resection, and a third developed adenocarcinoma five years after initial OP diagnosis. Additionally, three patients underwent open lung biopsy due to concern for malignancy, all of which confirmed benign etiologies consistent with OP in two of them and fibrosis/chronic inflammation in the third one. A detailed summary is provided in the table. Conclusion This study demonstrates that TBLB can reliably identify OP, but may miss underlying conditions such as malignancy. These findings highlight the importance of integrating radiologic assessment and close clinical follow-up, as secondary causes—including occult malignancy—may emerge over time and influence patient management. This abstract is funded by: None
Freihat et al. (Fri,) studied this question.