North West Interstitial Lung Disease Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
Adv Ther. 2019 Sep;36(9):2193-2204. doi: 10.1007/s12325-019-01036-y. Epub 2019 Jul 30.
Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease associated with significant morbidity and mortality. The diagnosis of IPF involves a combination of clinical history, radiological imaging and examination of histopathological samples in appropriate cases. Historically, transbronchial biopsy (TBB) has been used to obtain histological samples; however this lacks diagnostic accuracy. At present, surgical lung biopsy (SLB) is the gold standard technique for obtaining specimen samples; however this carries a significant mortality risk. Transbronchial lung cryobiopsy (TBLC) is a new technique that has been pioneered in the management of lung malignancy and offers a potential alternative to SLB. The technique employs a freezing probe, which is used to obtain lung tissue samples that are larger and better quality than traditional TBB samples. This affords TBLC an estimated diagnostic yield of 80% in interstitial lung disease. However, with limited evidence directly comparing TBLC to SLB, the diagnostic accuracy of the procedure has been uncertain. Common complications of TBLC include pneumothorax and bleeding. Mortality in TBLC is low compared with SLB, with exacerbation of IPF frequently reported as the cause. TBLC represents an exciting potential option in the diagnostic pathway in IPF; however its true value has yet to be determined.
特发性肺纤维化（IPF）是一种进行性肺部疾病，与较高的发病率和死亡率相关。IPF 的诊断涉及临床病史、影像学和在适当情况下检查组织病理学样本的综合评估。过去，经支气管活检（TBB）被用于获取组织学样本，但诊断准确性欠佳。目前，外科肺活检（SLB）是获取标本样本的金标准技术，但存在较高的死亡率风险。经支气管肺冷冻活检（TBLC）是一种新技术，已在肺癌的治疗中得到应用，并为 SLB 提供了一种潜在的替代方法。该技术采用冷冻探针，以获取比传统 TBB 样本更大、质量更好的肺组织样本。在间质性肺疾病中，TBLC 的诊断率估计为 80%。然而，由于直接比较 TBLC 和 SLB 的证据有限，该操作的诊断准确性尚不确定。TBLC 的常见并发症包括气胸和出血。与 SLB 相比，TBLC 的死亡率较低，IPF 恶化常被报告为其病因。TBLC 是 IPF 诊断路径中令人兴奋的潜在选择；但它的真正价值仍有待确定。
