Bondue Benjamin, Pieters Thierry, Alexander Patrick, De Vuyst Paul, Ruiz Patino Maria, Hoton Delphine, Remmelink Myriam, Leduc Dimitri
Department of Pneumology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Department of Pneumology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Pulm Med. 2017;2017:6794343. doi: 10.1155/2017/6794343. Epub 2017 Apr 20.
Transbronchial lung cryobiopsies (TBLCs) are a promising diagnostic tool in the setting of diffuse parenchymal lung diseases (DPLDs). However, no comparison with surgical lung biopsy (SLB) in the same patient is available. The diagnostic yield and safety data of TBLCs, as well as the result of SLB performed after TBLCs, were analysed in a multicentric Belgian study. A SLB was performed after TBLCs in absence of a definite pathological diagnosis or if a NSIP pattern was observed without related condition identified following multidisciplinary discussion. Between April 2015 and November 2016, 30 patients were included. Frequent complications included pneumothorax (20%) and bleeding (severe 7%, moderate 33%, and mild 53%). There was no mortality. The overall diagnostic yield was 80%. A SLB was performed in six patients (three without definite histological pattern and three with an NSIP). The surgical biopsy changed the pathological diagnosis into a UIP pattern in five patients and confirmed a NSIP pattern in one patient. TBLCs are useful in the diagnostic work-up of DPLDs avoiding a SLB in 80% of the patients. However, surgical biopsies, performed as a second step after TBLCs because of an indefinite diagnosis or a NSIP pattern, provide additional information supporting the interest of a sequential approach in these patients.
经支气管肺冷冻活检（TBLC）是弥漫性实质性肺疾病（DPLD）诊断中的一种有前景的诊断工具。然而，目前尚无同一患者中TBLC与外科肺活检（SLB）的比较。在一项比利时多中心研究中，分析了TBLC的诊断率和安全性数据，以及TBLC后进行SLB的结果。若未获得明确的病理诊断，或在多学科讨论后观察到非特异性间质性肺炎（NSIP）模式但未发现相关情况，则在TBLC后进行SLB。2015年4月至2016年11月期间，纳入了30例患者。常见并发症包括气胸（20%）和出血（严重出血7%，中度出血33%，轻度出血53%）。无死亡病例。总体诊断率为80%。6例患者进行了SLB（3例无明确组织学模式，3例为NSIP）。手术活检使5例患者的病理诊断变为寻常型间质性肺炎（UIP）模式，1例患者确诊为NSIP模式。TBLC在DPLD的诊断检查中很有用，80%的患者无需进行SLB。然而，由于诊断不明确或NSIP模式，在TBLC后第二步进行的手术活检提供了额外信息，支持了对这些患者采用序贯方法的意义。
