冷冻探头经支气管肺活检在弥漫性肺实质疾病中的诊断率及安全性：系统评价与Meta分析
Diagnostic Yield and Safety of Cryoprobe Transbronchial Lung Biopsy in Diffuse Parenchymal Lung Diseases: Systematic Review and Meta-Analysis.
作者信息
Dhooria Sahajal, Sehgal Inderpaul Singh, Aggarwal Ashutosh N, Behera Digambar, Agarwal Ritesh
机构信息
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
Respir Care. 2016 May;61(5):700-12. doi: 10.4187/respcare.04488. Epub 2016 Mar 1.
BACKGROUND
Transbronchial lung biopsy with flexible forceps is the most commonly used technique in diagnosis of diseases diffusely involving the lung parenchyma. Recently, transbronchial lung biopsy using the flexible cryoprobe (cryo-transbronchial lung biopsy) has also been reported. Herein, we perform a systematic review and meta-analysis describing the efficacy and safety of cryo-transbronchial lung biopsy.
METHODS
The PubMed and EMBASE databases were searched for studies reporting the outcomes of cryo-transbronchial lung biopsy in subjects with diffuse parenchymal lung involvement. The quality of individual studies was assessed using the QualSyst tool. The pooled diagnostic yield of cryo-transbronchial lung biopsy was calculated using proportion meta-analysis (random effects model). Heterogeneity was evaluated using the I(2) test and Cochran Q test. Publication bias was determined using both statistical and graphical methods.
RESULTS
Our search yielded 14 studies (1,183 subjects). The pooled diagnostic yield of cryo-transbronchial lung biopsy was 76.9% (95% CI 67.2-85.3) if only definitive diagnoses were considered and 85.9% (95% CI 78.2-92.2) if both definitive and probable diagnoses were considered. Four studies (321 subjects) the performance of flexible forceps biopsy and cryo-transbronchial lung biopsy. The diagnostic yield of cryo-transbronchial lung biopsy (86.3, 95% CI 80.2-90.8) was significantly higher than that of flexible forceps biopsy (56.5%, 95% CI 27.5-83.2) with an odds ratio of 6.7 (95% CI 3.6-12.4) and a number needed to treat of 4. Lung tissue was obtained in 98% of all samples with cryo-transbronchial lung biopsy and was free of compression artifacts. The size of samples obtained with cryo-transbronchial lung biopsy was significantly bigger compared with flexible forceps biopsy (20.4 vs 4.3 mm(2), P = .005). The complications of cryo-transbronchial lung biopsy included pneumothorax (6.8%), severe bleeding (0.3%), and death (0.1%). Clinical and statistical heterogeneity was present, and there was evidence of publication bias.
CONCLUSIONS
Cryo-transbronchial lung biopsy is a relatively safe procedure with good diagnostic yield in diseases diffusely involving the lung parenchyma.
背景
使用可弯曲活检钳的经支气管肺活检是诊断弥漫性累及肺实质疾病最常用的技术。最近，也有关于使用可弯曲冷冻探头进行经支气管肺活检（冷冻经支气管肺活检）的报道。在此，我们进行了一项系统评价和荟萃分析，描述冷冻经支气管肺活检的有效性和安全性。
方法
检索PubMed和EMBASE数据库，查找报告冷冻经支气管肺活检在弥漫性肺实质受累患者中结果的研究。使用QualSyst工具评估个体研究的质量。采用比例荟萃分析（随机效应模型）计算冷冻经支气管肺活检的汇总诊断率。使用I²检验和Cochran Q检验评估异质性。采用统计和图形方法确定发表偏倚。
结果
我们的检索共纳入14项研究（1183例受试者）。如果仅考虑明确诊断，冷冻经支气管肺活检的汇总诊断率为76.9%（95%CI 67.2 - 85.3）；如果同时考虑明确诊断和可能诊断，则为85.9%（95%CI 78.2 - 92.2）。四项研究（321例受试者）比较了可弯曲活检钳活检和冷冻经支气管肺活检的性能。冷冻经支气管肺活检的诊断率（86.3%，95%CI 80.2 - 90.8）显著高于可弯曲活检钳活检（56.5%，95%CI 27.5 - 83.2），优势比为6.7（95%CI 3.6 - 12.4），需治疗人数为4。在所有冷冻经支气管肺活检样本中，98%获取到了肺组织，且无压缩伪像。与可弯曲活检钳活检相比，冷冻经支气管肺活检获取的样本大小显著更大（20.4 vs 4.3 mm²，P = 0.005）。冷冻经支气管肺活检的并发症包括气胸（6.8%）、严重出血（0.3%）和死亡（0.1%）。存在临床和统计异质性，且有发表偏倚的证据。
结论
冷冻经支气管肺活检是一种相对安全的操作，对于弥漫性累及肺实质的疾病具有良好的诊断率。
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