Adil Eelam A, Kawai Kosuke, Dombrowski Natasha, Irace Alexandria L, Cunningham Michael J
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
Laryngoscope. 2017 Jan;127(1):6-13. doi: 10.1002/lary.26070. Epub 2016 Jun 16.
OBJECTIVES/HYPOTHESIS: To systematically review the literature regarding the efficacy of different biopsy sites and methods to obtain an adequate ciliary sample for ultrastructural examination with electron microscopy (EM) for the diagnosis of primary ciliary dyskinesia (PCD).
Systematic review and meta-analysis.
A literature search was conducted with respect to the diagnosis of PCD. English studies with five or more subjects were included. Successful biopsy was defined as an adequate ciliary sample to make or exclude the diagnosis of PCD.
Eight studies met inclusion criteria. These studies included 1,993 patients who underwent 2,299 ciliary biopsies. Included studies were level 3 or 4 evidence. The weighted pooled proportion of obtaining an adequate specimen from a nasal biopsy was 76% (95% confidence interval [CI], 64%-86%) versus 66% (95% CI, 62%-69%) for a tracheobronchial site (P = 0.10). The pooled proportion of obtaining an adequate sample was 68% for both brush and forceps biopsy groups (95% CI, 58%-77% and 54%-81%, respectively). Nasal scraping yielded a higher proportion of adequate specimens (pooled proportion of 92%; 95% CI, 82%-99%) than other techniques (P = 0.002).
Tissue biopsy is one component of diagnosing PCD. We found no significant difference between biopsy sites in terms of obtaining an adequate ciliary sample for EM evaluation. This suggests that nasal biopsy should be preferred for patients old enough to tolerate an office biopsy without the need for general anesthesia. The merits of nasal versus tracheobronchial biopsy in the operating room depend more on the risks and benefits of the procedure being performed.
NA Laryngoscope, 127:6-13, 2017.
目的/假设：系统回顾关于不同活检部位和方法获取足够纤毛样本用于电子显微镜（EM）超微结构检查以诊断原发性纤毛运动障碍（PCD）疗效的文献。
系统回顾和荟萃分析。
针对PCD的诊断进行文献检索。纳入有5名或更多受试者的英文研究。成功活检定义为获得足够的纤毛样本以做出或排除PCD的诊断。
八项研究符合纳入标准。这些研究包括1993例接受2299次纤毛活检的患者。纳入研究为3级或4级证据。经鼻活检获得足够标本的加权合并比例为76%（95%置信区间[CI]，64%-86%），而气管支气管部位为66%（95%CI，62%-69%）（P = 0.10）。刷检和钳取活检组获得足够样本的合并比例均为68%（95%CI分别为58%-77%和54%-81%）。鼻刮片获得足够标本的比例（合并比例为92%；95%CI，82%-99%）高于其他技术（P = 0.002）。
组织活检是诊断PCD的一个组成部分。我们发现活检部位在获取足够的纤毛样本用于EM评估方面无显著差异。这表明对于年龄足够大、能够耐受门诊活检且无需全身麻醉的患者，应首选经鼻活检。在手术室中经鼻活检与气管支气管活检的优缺点更多地取决于所进行操作的风险和益处。
NA 《喉镜》，2017年，第127卷，第6 - 13页
