Poletti Venerino, Ravaglia Claudia, Tomassetti Sara
aDepartment of Diseases of the Thorax, Azienda USL Romagna, GB Morgagni Hospital, Forlì, Italy bDepartment of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
Curr Opin Pulm Med. 2016 May;22(3):289-96. doi: 10.1097/MCP.0000000000000272.
The diagnostic yield of conventional transbronchial lung biopsy varies among various parenchymal lung diseases: in pulmonary sarcoidosis and lymphangitis carcinomatosa, a diagnosis can be obtained in up to 80% of patients; this method is considered inadequate, however, in identifying more complex histological patterns such as usual interstitial pneumonitis or nonspecific interstitial pneumonitis, mainly because the specimens are tiny and the interpretation is confounded by crush artifacts. Recently, the use of cryoprobes has achieved a significant impact on this issue. This review is about this promising application of cryobiopsy in the diagnostic process of diffuse parenchymal lung diseases.
Recent studies document that with transbronchial cryobiopsies, the diagnosis of usual interstitial pneumonitis can be made confidently by pathologists with a good interobserver agreement. Pneumothorax is the main complication (reported in up to one-quarter of cases in some series); bronchial bleeding is usually controlled using Fogarty balloon.
Transbronchial cryobiopsy is a promising new technique that may become a valid alternative to surgical lung biopsy in the near feature.
传统经支气管肺活检在不同实质性肺疾病中的诊断率各不相同:在肺结节病和癌性淋巴管炎中,高达80%的患者可获得诊断;然而,在识别更复杂的组织学模式如特发性肺纤维化或非特异性间质性肺炎时,该方法被认为是不足的,主要是因为标本微小且解读易受挤压假象干扰。最近,冷冻探头的使用对这一问题产生了重大影响。本综述围绕冷冻活检在弥漫性实质性肺疾病诊断过程中的这一有前景的应用展开。
近期研究表明,经支气管冷冻活检可使病理学家自信地诊断特发性肺纤维化,观察者间一致性良好。气胸是主要并发症(在某些系列报道中高达四分之一的病例);支气管出血通常使用Fogarty球囊控制。
经支气管冷冻活检是一项有前景的新技术,可能在不久的将来成为外科肺活检的有效替代方法。