1 Department of Medicine and.
2 Department of Community Health Sciences, University of Calgary, Calgary Alberta, Canada.
Ann Am Thorac Soc. 2016 Oct;13(10):1828-1838. doi: 10.1513/AnnalsATS.201606-461SR.
The diagnostic usefulness and safety of transbronchial lung cryobiopsy for the evaluation of interstitial lung disease remain unclear.
This systematic review and metaanalysis aims to establish the diagnostic accuracy and yield of transbronchial cryobiopsy for interstitial lung diseases.
We searched MedLine, EMBASE, Cochrane Central Register of Controlled Trials, and conference proceedings to identify studies assessing the diagnostic accuracy (compared with surgical biopsy) or yield of transbronchial lung cryobiopsy for interstitial lung disease (from database inception to January 2016). The diagnostic accuracy and yield were quantified and stratified by the method of diagnosis determination (histologic interpretation in isolation vs. incorporation within a multidisciplinary discussion). The frequency of procedure-related complications was also assessed from these reports. For full-text studies, random-effects models were used to calculate pooled estimates of diagnostic accuracy, yield, and complication frequency.
Of 900 citations, 11 studies were selected for inclusion in this systematic review (7 full text, 4 abstracts). The selected studies reported on a total of 731 patients. No studies reported the diagnostic accuracy of transbronchial cryobiopsy. Diagnostic yield ranged from 74 to 98% when transbronchial cryobiopsy findings were interpreted in isolation, with a pooled estimate of 83% (95% confidence interval [CI], 73-94). Diagnostic yield ranged from 51 to 98% when transbronchial cryobiopsy was reviewed within a multidisciplinary discussion, with a pooled estimate of 79% (95% CI, 65-93). Pooled estimates for pneumothorax and moderate/severe bleeding were 12% (95% CI, 3-21) and 39% (95% CI, 3-76), respectively.
The diagnostic accuracy of transbronchial lung cryobiopsy cannot be determined given the absence of studies directly comparing cryobiopsy diagnoses with diagnoses derived from surgical lung biopsies interpreted within multidisciplinary discussions. The histopathological and multidisciplinary discussion-based diagnostic yield of transbronchial cryobiopsy appears high, but with variable frequencies of complications dominated by pneumothorax and moderate-to-severe hemorrhage.
经支气管肺冷冻活检术在评估间质性肺疾病中的诊断价值和安全性尚不清楚。
本系统评价和荟萃分析旨在确定经支气管冷冻活检术诊断间质性肺疾病的准确性和检出率。
我们检索了 MedLine、EMBASE、Cochrane 中心对照试验注册库和会议记录，以评估评估间质性肺疾病的经支气管肺冷冻活检术（从数据库建立到 2016 年 1 月）的诊断准确性（与外科活检比较）或检出率的研究。通过诊断确定方法（孤立的组织学解释与多学科讨论相结合）对诊断准确性和检出率进行量化和分层。还从这些报告中评估了与手术相关的并发症的发生频率。对于全文研究，采用随机效应模型计算诊断准确性、检出率和并发症发生率的汇总估计值。
在 900 篇引文中有 11 篇研究被纳入本系统评价（7 篇全文，4 篇摘要）。入选的研究共报道了 731 例患者。没有研究报告经支气管冷冻活检术的诊断准确性。当经支气管冷冻活检结果孤立解读时，诊断检出率范围为 74%至 98%，汇总估计值为 83%（95%置信区间[CI]，73%至 94%）。当经支气管冷冻活检在多学科讨论中进行评估时，诊断检出率范围为 51%至 98%，汇总估计值为 79%（95%CI，65%至 93%）。气胸和中重度出血的汇总估计值分别为 12%（95%CI，3%至 21%）和 39%（95%CI，3%至 76%）。
鉴于没有研究直接比较经支气管肺冷冻活检术诊断与多学科讨论中外科肺活检解释的诊断，因此无法确定经支气管肺冷冻活检术的诊断准确性。经支气管冷冻活检的组织病理学和多学科讨论为基础的诊断检出率似乎很高，但并发症的发生率存在差异，以气胸和中重度出血为主。
