Roden Anja C, Kern Ryan M, Aubry Marie Christine, Jenkins Sarah M, Yi Eunhee S, Scott John P, Maldonado Fabien
From the Department of Laboratory Medicine and Pathology (Drs Roden, Aubry, and Yi);
the Division of Pulmonary & Critical Care Medicine (Drs Kern, Scott, and, Maldonado);
Arch Pathol Lab Med. 2016 Apr;140(4):303-11. doi: 10.5858/arpa.2015-0294-OA. Epub 2015 Oct 21.
Transbronchial cryobiopsy technique yields larger biopsies with enhanced quality. The benefits and safety of cryobiopsies have not been thoroughly studied in lung allografts.
To compare size, quality, reproducibility of interpretation of rejection and complications of cryobiopsies with those of conventional biopsies from lung allografts.
All cryobiopsies (March 2014-January 2015) of lung allografts performed at Mayo Clinic, Rochester, and medical records were reviewed. For comparison, conventional biopsies from the same patient or, if unavailable, from a random patient, were selected. Two pathologists blinded to outcome reviewed all biopsies. Specimen volume, number of alveoli, small airways, and pulmonary vessels were counted and statistically compared.
Fifty-four biopsies (27 cryobiopsies) from 18 patients (11 men) were reviewed. A median of 3 (range, 2-5) and 10 (range, 6-12) specimens were obtained with cryobiopsies and conventional biopsies, respectively. Cryobiopsies were larger and contained more alveoli (P < .001, both) and small airways (P = .04). Conventional biopsies showed more fresh alveolar hemorrhage (procedural) and crush artifact/atelectasis (P < .001, both). Cryobiopsies contained more pulmonary veins and venules (P < .001). There was no significant difference between the types of biopsies with respect to the reviewers' agreement on grades of rejection. Complications were more frequent in the cryobiopsy group, though the difference was not statistically significant.
Cryobiopsies of lung allografts are larger and have less artifact. However, complications occur and should be considered. Three cryobiopsy specimens appear sufficient for histopathologic evaluation of lung allografts.
经支气管冷冻活检技术可获取更大且质量更高的活检样本。冷冻活检在肺移植中的益处和安全性尚未得到充分研究。
比较肺移植冷冻活检与传统活检在样本大小、质量、排斥反应判读的可重复性及并发症方面的差异。
回顾了梅奥诊所罗切斯特分院在2014年3月至2015年1月期间对肺移植进行的所有冷冻活检，并查阅了病历。为作比较，选取了同一患者的传统活检样本，若无法获取，则选取随机患者的传统活检样本。两名对结果不知情的病理学家对所有活检样本进行了评估。对样本体积、肺泡数量、小气道及肺血管进行计数并进行统计学比较。
对18例患者（11例男性）的54次活检（27次冷冻活检）进行了回顾。冷冻活检和传统活检分别获取的样本中位数为3个（范围2 - 5个）和10个（范围6 - 12个）。冷冻活检样本更大，包含更多的肺泡（均P < 0.001）和小气道（P = 0.04）。传统活检显示更多的新鲜肺泡出血（操作相关）和挤压伪像/肺不张（均P < 0.001）。冷冻活检样本包含更多的肺静脉和小静脉（P < 0.001）。在活检类型之间，病理学家对排斥反应分级的一致性方面没有显著差异。冷冻活检组的并发症更常见，尽管差异无统计学意义。
肺移植冷冻活检样本更大且伪像更少。然而，并发症会发生，应予以考虑。三个冷冻活检样本似乎足以进行肺移植的组织病理学评估。
