Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of Cincinnati, Cincinnati, OH 45219, USA.
Department of Medicine, University of Cincinnati, Cincinnati, OH 45219, USA.
Respir Med. 2017 Oct;131:65-69. doi: 10.1016/j.rmed.2017.08.003. Epub 2017 Aug 4.
Transbronchial lung cryobiopsy (TBLC) is a novel technique that has proved to be useful in diagnosing various interstitial lung diseases (ILD). The use of TBLC to diagnose sarcoidosis in an unselected patient population is unknown, and could be complimentary to endobronchial ultrasound fine needle aspiration (EBUS-FNA).
A retrospective analysis of 36 patients in a single, tertiary-care, academic medical center was conducted to describe the yield of both EBUS-FNA and TBLC in the diagnosis of suspected sarcoidosis over a three year period. A grading system to evaluate the presence and extent of specific radiographic features on computed tomography chest imaging studies was compared to the results of EBUS-FNA and TBLC. Complications associated with the procedures were also noted.
The overall diagnostic yield in our cohort (all pathologic diagnosis considered) was 80.6% (29 out of 36 patients had a definite pathologic diagnosis). Eighteen patients referred for possible sarcoidosis had a positive bronchoscopic specimen confirming the diagnosis of sarcoidosis. For those patients with a pathologic diagnosis of sarcoidosis, the diagnostic yield for EBUS-FNA and TBLC was 66.7% each (12 out of 18 patients), while the combined diagnostic yield for EBUS-FNA and TBLC increased to 100%. For all cases, the pneumothorax rate was 11.1%.
TBLC appears to be a safe and complimentary technique to diagnose sarcoidosis and could be considered part of the diagnostic armamentarium in bronchoscopic centers.
经支气管肺冷冻活检（TBLC）是一种新型技术，已被证明对诊断各种间质性肺疾病（ILD）有用。TBLC 用于诊断未经选择的患者人群中的结节病尚不清楚，并且可能与支气管内超声引导下细针抽吸（EBUS-FNA）互补。
对单个三级学术医疗中心的 36 例患者进行了回顾性分析，以描述在三年期间，EBUS-FNA 和 TBLC 在诊断疑似结节病中的诊断率。一种评估 CT 胸部成像研究中特定放射学特征的存在和程度的分级系统与 EBUS-FNA 和 TBLC 的结果进行了比较。还记录了与这些程序相关的并发症。
在我们的队列中（所有病理诊断均考虑在内），总体诊断率为 80.6%（36 例患者中有 29 例具有明确的病理诊断）。18 例因疑似结节病而转介的患者有阳性支气管镜标本证实为结节病。对于那些有病理诊断为结节病的患者，EBUS-FNA 和 TBLC 的诊断率分别为 66.7%（18 例中有 12 例），而 EBUS-FNA 和 TBLC 的联合诊断率增加到 100%。所有病例的气胸发生率为 11.1%。
TBLC 似乎是一种安全且互补的诊断结节病的技术，可被视为支气管镜中心诊断工具的一部分。
