Department of Pneumology, Hôpital Erasme, Université libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium.
Department of Pneumology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Respir Res. 2020 Sep 4;21(1):231. doi: 10.1186/s12931-020-01487-w.
Although increasing data supports the use of transbronchial lung cryobiopsies (TBLCs) for the diagnosis of diffuse parenchymal lung diseases (DPLDs), its role as an alternative to surgical lung biopsy (SLB) is still under debate. The aim of this study was to assess the benefit of additional SLBs performed in selected patients after TBLCs.
We conducted a multicentric Belgian prospective trial in which SLBs were performed after TBLCs when the pathological diagnosis was uncertain or if a nonspecific interstitial pneumonia (NSIP) pattern was observed hypothesizing that SLB could provide additional information and that a co-existent UIP pattern could be missed.
Eighty-one patients with TBLCs performed for a DPLD were included in the study between April 2015 and December 2019. A specific histological diagnosis was obtained in 52 patients (64%) whereas no pathological diagnosis following TBLCs was obtained in 13 patients (16%) and a pattern suggestive of a NSIP was observed in 16 patients (20%). Fourteen out of these 29 patients had SLBs after TBLCs. SLBs showed a UIP pattern in 11 (79%), a pattern suggestive of a hypersensitivity pneumonitis in two (14%) and a NSIP pattern in one patient (7%). Among the 16 patients with pathological NSIP following TBLCs, six underwent a SLBs showing a UIP in five and confirming a NSIP in one patient only. A retrospective pathological analysis of patients having both procedures showed a lower diagnostic confidence and agreement among pathologists for TBLCs compared to SLBs. Major factors underlying the added value of SLBs were the bigger size of the sample as well as the subpleural localization of the biopsies.
TBLCs are useful in the setting of DPLDs with a good diagnostic yield. However, our study suggests that SLB provides critical additional information in case TBLCs are inconclusive or show a pattern suggestive of a NSIP, questioning the accuracy of TBLC to adequately identify this histological pattern.
虽然越来越多的数据支持经支气管肺冷冻活检（TBLC）用于诊断弥漫性实质性肺疾病（DPLD），但其作为外科肺活检（SLB）的替代方法的作用仍存在争议。本研究旨在评估在 TBLC 后对选定患者进行额外 SLB 的益处。
我们进行了一项多中心比利时前瞻性试验，其中在 TBLC 后进行 SLB，如果病理诊断不确定或观察到非特异性间质性肺炎（NSIP）模式，假设 SLB 可以提供额外的信息，并且可能会错过共存的 UIP 模式。
2015 年 4 月至 2019 年 12 月期间，对 81 例因 DPLD 行 TBLC 的患者进行了研究。52 例患者（64%）获得了特定的组织学诊断，13 例患者（16%）在 TBLC 后未获得病理诊断，16 例患者（20%）观察到提示 NSIP 的模式。这 29 例患者中有 14 例在 TBLC 后进行了 SLB。SLB 显示 UIP 模式 11 例（79%），提示过敏反应性肺炎 2 例（14%），NSIP 模式 1 例（7%）。在 16 例 TBLC 后出现 NSIP 病理的患者中，6 例行 SLB，5 例显示 UIP，仅 1 例确认 NSIP。对同时进行这两种检查的患者进行回顾性病理分析显示，与 SLB 相比，TBLC 的病理医生诊断信心和一致性较低。SLB 具有附加价值的主要因素是样本更大，活检位于胸膜下。
TBLC 在 DPLD 中具有良好的诊断效果。然而，我们的研究表明，在 TBLC 不确定或提示 NSIP 模式的情况下，SLB 提供了关键的额外信息，这质疑了 TBLC 识别这种组织学模式的准确性。
