Cho Roy, Zamora Felix, Gibson Heidi, Dincer H Erhan
Department of Interventional Pulmonary, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine.
Division of Cardiopulmonary Services, University of Minnesota, Minneapolis, MN.
J Bronchology Interv Pulmonol. 2019 Jan;26(1):15-21. doi: 10.1097/LBR.0000000000000514.
Surgical lung biopsy (SLB) is the gold standard to aid diagnosis of interstitial lung disease (ILD). Complication rates are restrictive as routine approach for all patients with ILD. Transbronchial lung cryobiopsy (TBLC) is presumed to be a safe, less invasive alternative to assist multidisciplinary discussions regarding the diagnosis of ILD. Varying practice patterns and lack of consistent guidelines prohibit wide support of this technique. The purpose of this study was to evaluate safety and diagnostic yield of TBLC, with highlight of distinct technical features, in ILD.
Retrospective study of patients with ILD on the basis of high-resolution chest computed tomography who underwent TBLC.
Of 121 TBLC, 40 patients (mean age, 57.2±13 y; 28 men) with ILD were referred for biopsy. Procedures were performed in endoscopy suite (60%) or operating room by using 1.9-mm cryoprobe. Biopsies were performed in 2 lobes with at least 3 to 5 specimens >5 mm in diameter. The average diameter and area of specimens were 5.7±2 mm and 40±2 mm, respectively. The most common diagnosis was nonspecific interstitial pneumonitis; usual interstitial pneumonia was diagnosed in 1 patient. Of 6 nondiagnostic specimens, 2 underwent SLB with subsequent diagnoses. Final histopathologic diagnostic rate was 85%. Bleeding was the most frequent complication.
We provided a detailed description of our TLBC technique and highlighted areas of similarity and differences among comparative studies and attest that TBLC is a safe alternative to SLB in the diagnosis of ILD. Our data also indicated the tendency for moderate-to-severe bleeding occurred more in the endoscopy suite.
外科肺活检（SLB）是辅助诊断间质性肺疾病（ILD）的金标准。由于并发症发生率限制了其作为所有ILD患者的常规检查方法。经支气管肺冷冻活检（TBLC）被认为是一种安全、侵入性较小的检查方法，有助于多学科讨论ILD的诊断。不同的操作模式和缺乏统一的指南限制了该技术的广泛应用。本研究的目的是评估TBLC在ILD诊断中的安全性和诊断率，并突出其独特的技术特点。
基于高分辨率胸部计算机断层扫描对接受TBLC的ILD患者进行回顾性研究。
在121例TBLC中，40例（平均年龄57.2±13岁；男性28例）ILD患者接受了活检。操作在内镜室（60%）或手术室进行，使用1.9毫米冷冻探头。在两个肺叶进行活检，至少获取3至5个直径>5毫米的标本。标本的平均直径和面积分别为5.7±2毫米和40±2平方毫米。最常见的诊断是非特异性间质性肺炎；1例患者诊断为寻常型间质性肺炎。在6例未明确诊断的标本中，2例接受了SLB并随后确诊。最终组织病理学诊断率为85%。出血是最常见的并发症。
我们详细描述了TLBC技术，突出了比较研究之间的异同点，并证明TBLC在ILD诊断中是SLB的一种安全替代方法。我们的数据还表明，中到重度出血在内镜室发生的倾向更高。
