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经支气管肺冷冻活检能否为哮喘患者提供有用信息?

Does transbronchial lung cryobiopsy give useful information in asthmatic patients?

作者信息

Colella Sara, Ravaglia Claudia, Massaccesi Chiara, D'Emilio Vittorio, Panella Gianluca, Fioretti Federica, Conte Emanuele Giovanni, Collina Guido, Pela Riccardo, Poletti Venerino

机构信息

Pulmonology Unit, "C. & G. Mazzoni" Hospital, Ascoli Piceno, Italy.

Department of Thoracic Diseases, "GB. Morgagni" Hospital, Forlì, Italy.

出版信息

Multidiscip Respir Med. 2019 Apr 8;14:12. doi: 10.1186/s40248-019-0176-5. eCollection 2019.

Abstract

INTRODUCTION

Lung biopsy in asthmatic patients is justified in case of atypical presentations of asthma, when other differential diagnoses, such as hypersensitivity pneumonitis or eosinophilic granulomatosis with polyangiitis, could be possible or for research purposes.

AIM

We aim to describe the utility and the safety of TBLC (transbronchial lung cryobiopsy) in asthmatic patients, providing data on the pathological changes occurring in the airways and in the lung parenchyma.

METHODS

We reviewed asthmatic patients that underwent TBLC, that eventually had only a final diagnosis of asthma.

RESULTS

Three patients were detected. TBLC described pathological abnormalities in peribronchiolar and alveolar spaces already well identified with SLB (surgical lung biopsy); the pathological information provided could be useful to better understand the pathobiology of the disease. Finally, we had no complications, confirming a satisfactory safety profile of TBLC.

CONCLUSION

We suggest the potential role of TBLC in asthmatic patients: its safety and its acceptable diagnostic accuracy lead to consider this procedure instead of SLB when histological changes in lung parenchyma are needed for the differential diagnosis. Furthermore, TLBC could be useful for research in the pathobiology of asthma and severe asthma.

摘要

引言

在哮喘患者出现非典型表现、可能存在其他鉴别诊断(如过敏性肺炎或嗜酸性肉芽肿性多血管炎)时,或出于研究目的时,进行肺活检是合理的。

目的

我们旨在描述经支气管肺冷冻活检(TBLC)在哮喘患者中的实用性和安全性,提供有关气道和肺实质中发生的病理变化的数据。

方法

我们回顾了接受TBLC的哮喘患者,这些患者最终仅确诊为哮喘。

结果

检测到3例患者。TBLC描述了在细支气管周围和肺泡空间中已通过外科肺活检(SLB)明确识别的病理异常;所提供的病理信息可能有助于更好地理解该疾病的病理生物学。最后,我们没有出现并发症,证实了TBLC具有令人满意的安全性。

结论

我们提出TBLC在哮喘患者中的潜在作用:其安全性和可接受的诊断准确性使得在需要肺实质组织学变化进行鉴别诊断时,可考虑采用该方法替代SLB。此外,TLBC可能有助于哮喘和重度哮喘病理生物学的研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/219f/6452509/f97f80275ebf/40248_2019_176_Fig1_HTML.jpg

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本文引用的文献

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Pathobiology of severe asthma.严重哮喘的病理生物学。
Annu Rev Pathol. 2015;10:511-45. doi: 10.1146/annurev-pathol-012414-040343. Epub 2014 Nov 24.

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