Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy; Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy.
Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy.
Lancet Respir Med. 2020 Aug;8(8):786-794. doi: 10.1016/S2213-2600(20)30122-3.
Transbronchial lung cryobiopsy (TBLC) has been introduced recently in the diagnosis of interstitial lung diseases. We aimed to evaluate the prognostic significance of the distinction between idiopathic pulmonary fibrosis and other interstitial lung diseases with the use of TBLC data in multidisciplinary team (MDT) diagnosis.
In this single-centre, retrospective, investigator-initiated comparative study, we evaluated consecutive patients without a definite usual interstitial pneumonia pattern on high-resolution CT, who presented to the GB Morgagni Hospital (Forlì, Italy), and who underwent TBLC (Jan 1, 2011, to Dec 31, 2014) or surgical lung biopsy (SLB; Jan 1, 2002, to Dec 31, 2016). Three pathologists reviewed the specimens, masked to clinical information. MDT evaluation was done before and after biopsy. The primary endpoint was the prognostic significance of the MDT diagnostic separation between idiopathic pulmonary fibrosis and other interstitial lung diseases in patients undergoing TBLC. Mortality was evaluated by means of Cox regression analysis.
We evaluated 500 consecutive cases, 426 of which were included: 266 had TBLC and 160 had SLB. 189 patients had idiopathic pulmonary fibrosis, 143 had other fibrotic interstitial lung diseases, and 94 had non-fibrotic interstitial lung diseases. Patients undergoing TBLC had more comorbidities and better preserved lung function compared with those undergoing SLB; among patients with a final MDT diagnosis of idiopathic pulmonary fibrosis, patients undergoing TBLC were older, had more comorbidities, and had a different post-biopsy treatment profile than those who received SLB. The distinction between idiopathic pulmonary fibrosis and other interstitial lung diseases made by MDT diagnosis on the basis of TBLC biopsy had clear prognostic significance, with a 5-year transplant-free survival of 68% (95% CI 57-76) in patients with an MDT idiopathic pulmonary fibrosis diagnosis based on TBLC compared with 93% (87-96) in patients without an idiopathic pulmonary fibrosis diagnosis based on TBLC (hazard ratio 5·28, 95% CI 2·72-10·04; p<0·0001). This distinction remained statistically significant in a multivariate analysis controlling for age, sex, smoking status, comorbidities, pulmonary function, and high-resolution CT patterns (p=0·02).
TBLC makes an important diagnostic contribution in interstitial lung disease, on the basis of the prognostic distinction between idiopathic pulmonary fibrosis and other interstitial lung diseases when TBLC findings are included in multidisciplinary diagnosis.
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经支气管肺冷冻活检（TBLC）最近已被引入到间质性肺疾病的诊断中。我们旨在通过多学科团队（MDT）诊断中使用 TBLC 数据来评估区分特发性肺纤维化和其他间质性肺疾病的预后意义。
在这项单中心、回顾性、研究者发起的比较研究中，我们评估了连续就诊于意大利福尔利 GB 莫尔加尼医院且高分辨率 CT 无明确间质性肺炎模式的患者，并对这些患者进行了 TBLC（2011 年 1 月 1 日至 2014 年 12 月 31 日）或外科肺活检（SLB；2002 年 1 月 1 日至 2016 年 12 月 31 日）。三位病理学家在不了解临床信息的情况下对标本进行了审查。在活检前和活检后进行了 MDT 评估。主要终点是在接受 TBLC 的患者中，MDT 诊断在特发性肺纤维化和其他间质性肺疾病之间的区分的预后意义。通过 Cox 回归分析评估死亡率。
我们评估了 500 例连续病例，其中 426 例被纳入：266 例接受了 TBLC，160 例接受了 SLB。189 例患者患有特发性肺纤维化，143 例患有其他纤维性间质性肺疾病，94 例患有非纤维性间质性肺疾病。与接受 SLB 的患者相比，接受 TBLC 的患者有更多的合并症和更好的肺功能保留；在最终 MDT 诊断为特发性肺纤维化的患者中，接受 TBLC 的患者年龄更大、合并症更多，且活检后的治疗方案也与接受 SLB 的患者不同。MDT 基于 TBLC 活检对特发性肺纤维化和其他间质性肺疾病的区分具有明确的预后意义，与 MDT 基于 TBLC 活检诊断无特发性肺纤维化的患者相比，基于 TBLC 活检诊断为特发性肺纤维化的患者的 5 年无移植生存率为 68%（95%CI 57-76），而无 TBLC 诊断为特发性肺纤维化的患者为 93%（87-96）（风险比 5.28，95%CI 2.72-10.04；p<0.0001）。在控制年龄、性别、吸烟状况、合并症、肺功能和高分辨率 CT 模式的多变量分析中，这种差异仍然具有统计学意义（p=0.02）。
TBLC 通过在多学科诊断中纳入 TBLC 结果，对特发性肺纤维化和其他间质性肺疾病之间的预后进行区分，从而在间质性肺疾病的诊断中做出了重要的诊断贡献。
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