Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Department of Respirology, HARUHI Respiratory Medical Hospital, Kiyosu, Japan.
Diagn Pathol. 2019 Dec 4;14(1):131. doi: 10.1186/s13000-019-0908-z.
Increasing evidence indicates the utility of transbronchial lung cryobiopsy (TBLC) for the diagnosis of interstitial lung disease (ILD). However, only one study has compared TBLC and surgical lung biopsy (SLB) performed on the same patients.
We identified seven patients with ILD with TBLC and SLB. We evaluated the clinical characteristics and made a pathological diagnosis based on the official ATS/ERS/JRS/ALAT clinical practice guideline of idiopathic pulmonary fibrosis with both TBLC and SLB.
Six cases were diagnosed as Usual interstitial pneumonia (UIP) in both TBLC and SLB. One case was diagnosed as indeterminate for UIP with TBLC and probable UIP with SLB. Etiological diagnosis with TBLC and SLB were concordant in 2 cases of idiopathic pulmonary fibrosis (IPF) but discordant for other diagnoses. Major histological findings of UIP including dense fibrosis, peripheral distribution, and fibroblastic foci showed high concordance between TBLC and SLB, which implies that TBLC can reliably detect these features. In contrast, loose fibrosis, cellular infiltration, and airway disease showed poor concordance between the two methods.
Our study showed that TBLC is useful for UIP diagnosis but not for other ILD. With a multidisciplinary approach, diagnosis of IPF may be determined by TBLC, whereas ILD other than IPF may require SLB.
越来越多的证据表明经支气管肺冷冻活检（TBLC）在诊断间质性肺疾病（ILD）方面具有一定的应用价值。然而，仅有一项研究比较了在同一患者中进行的 TBLC 和外科肺活检（SLB）。
我们共纳入了 7 例接受了 TBLC 和 SLB 的 ILD 患者。我们根据 TBLC 和 SLB 的官方 ATS/ERS/JRS/ALAT 特发性肺纤维化临床实践指南评估了临床特征，并进行了病理学诊断。
TBLC 和 SLB 均诊断 6 例为寻常型间质性肺炎（UIP）。1 例 TBLC 诊断为 UIP 不确定，而 SLB 诊断为可能 UIP。2 例特发性肺纤维化（IPF）的 TBLC 和 SLB 的病因诊断一致，但其他诊断不一致。TBLC 和 SLB 的 UIP 的主要组织学发现包括密集纤维化、外周分布和成纤维细胞灶，这两种方法之间具有高度一致性，这意味着 TBLC 可以可靠地检测到这些特征。相比之下，松散纤维化、细胞浸润和气道疾病在两种方法之间一致性较差。
我们的研究表明，TBLC 有助于 UIP 的诊断，但对其他 ILD 则不然。通过多学科方法，TBLC 可能有助于确定 IPF 的诊断，而其他非 IPF 的 ILD 可能需要 SLB。
