Department of Pulmonology, Centro Hospitalar de São João, Porto, Portugal.
Department of Radiology, Centro Hospitalar de São João, Porto, Portugal.
Respiration. 2018;96(5):455-463. doi: 10.1159/000489934. Epub 2018 Aug 21.
Accurate diagnosis is essential for successful management of diffuse lung disease (DLD). Histopathology may sometimes be necessary. Surgical lung biopsy, the gold standard, carries a risk of morbidity and mortality. Computed tomography (CT) guided transthoracic lung biopsy (CT-TLB) is a minimally invasive method for obtaining lung tissue. However, its diagnostic yield is unknown in DLD.
To assess the diagnostic yield of CT-TLB in DLD according to the predominant high-resolution CT (HRCT) patterns.
Between January 2009 and December 2016, we enrolled all consecutive adult patients with suspicion of DLD who underwent CT-guided transthoracic lung biopsy during the diagnostic work-up. All biopsies were performed by a senior interventional radiologist using CT fluoroscopy.
The study included 169 patients (50.3% men) with a mean (±SD) age of 58.3 ± 14 years. Consolidation was the predominant HRCT pattern. A definitive or probable diagnosis was made in 66.3%. The most frequent diagnosis was organizing pneumonia (36.2%). Diagnostic yield was higher when the predominant HRCT pattern was consolidation or nodular. The most common complication was pneumothorax (17.8%); other complications included mild hemoptysis (7.7%), hemothorax (1.2%), and death (0.59%). No acute exacerbation of the underlying condition was observed.
CT-TLB proved to be accurate and safe for the diagnosis of DLD. The overall diagnostic yield of the procedure was 66.3%. Given its low complication rates, CT-TLB can be an option in patients whose respiratory function is seriously impaired and in those with substantial comorbidities, where more invasive procedures cannot be performed for reasons of safety.
准确的诊断对于弥漫性肺疾病（DLD）的成功治疗至关重要。有时可能需要进行组织病理学检查。作为金标准的外科肺活检存在一定的发病率和死亡率风险。CT 引导下经胸肺活检（CT-TLB）是一种获取肺组织的微创方法。然而，其在 DLD 中的诊断率尚不清楚。
根据主要高分辨率 CT（HRCT）模式评估 CT-TLB 在 DLD 中的诊断率。
在 2009 年 1 月至 2016 年 12 月期间，我们纳入了所有因怀疑患有 DLD 而在诊断过程中接受 CT 引导下经胸肺活检的连续成年患者。所有活检均由一名资深介入放射科医生使用 CT 透视进行。
本研究共纳入 169 例（50.3%为男性）患者，平均（±SD）年龄为 58.3±14 岁。实变是主要的 HRCT 模式。明确或可能的诊断率为 66.3%。最常见的诊断是机化性肺炎（36.2%）。当主要 HRCT 模式为实变或结节时，诊断率更高。最常见的并发症是气胸（17.8%）；其他并发症包括轻度咯血（7.7%）、血胸（1.2%）和死亡（0.59%）。未观察到基础疾病的急性恶化。
CT-TLB 被证明是诊断 DLD 准确且安全的方法。该操作的总体诊断率为 66.3%。鉴于其较低的并发症发生率，对于那些呼吸功能严重受损且因安全原因无法进行更具侵袭性操作的患者，CT-TLB 是一种可行的选择。
