Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology.
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Am J Respir Crit Care Med. 2021 May 15;203(10):1306-1313. doi: 10.1164/rccm.202009-3688OC.
Transbronchial lung cryobiopsy (TBLC) is an emerging technique for interstitial lung disease diagnosis. Good histopathologic agreement between TBLC and surgical lung biopsy (SLB) was demonstrated in the COLDICE (Cryobiopsy versus Open Lung Biopsy in the Diagnosis of Interstitial Lung Disease Alliance) study; however, diagnostic confidence was frequently lower for TBLC than SLB. To characterize specific features of TBLC predictive of usual interstitial pneumonia (UIP) in corresponding SLB and to identify clinical indices predictive of biopsy concordance. The COLDICE study was a prospective, multicenter study investigating diagnostic agreement between TBLC and SLB. The participants underwent both procedures with blinded pathologist analysis of specimens, applying international guideline criteria. The TBLC features predictive of UIP in the paired SLB and predictive features of overall concordance were analyzed. A total of 65 patients (66.1 ± 9.3 yr; FVC, 84.7 ± 14.2%; Dl, 63.4 ± 13.8%) participated in the COLDICE study. UIP was identified in 33/65 (50.8%) SLB, and 81.5% were concordant with corresponding TBLC (κ, 0.61; 95% confidence interval [CI], 0.38-0.77). The UIP guideline criteria of "predominantly subpleural or paraseptal fibrosis" was infrequently reported in TBLC (8/33, 24.2%), whereas "patchy fibrosis," "fibroblast foci," and the "absence of alternative diagnostic features" were frequently observed in TBLC. The combination of these three features strongly predicted UIP in paired SLB (odds ratio [OR], 23.4; 95% CI, 6.36-86.1; < 0.0001). Increased numbers of TBLC samples predicted histopathologic concordance with SLB (OR, 1.8; 95% CI, 1.08-3.01; = 0.03). The predictors of discordance included older age, family history, and radiologic asymmetry. Subpleural and/or paraseptal fibrosis were not essential for diagnosing UIP in TBLC, provided that other guideline criteria features were present. The diagnostic accuracy of TBLC was strengthened when increased numbers of samples were taken. Clinical trial registered with www.anzctr.org.au (ACTRN12615000718549).
经支气管肺冷冻活检（TBLC）是一种新兴的诊断间质性肺疾病的技术。在 COLDICE（冷冻活检与开胸肺活检在间质性肺疾病联盟中的诊断）研究中，TBLC 与外科肺活检（SLB）之间显示出良好的组织病理学一致性；然而，TBLC 的诊断信心通常低于 SLB。为了描述 TBLC 对相应 SLB 中常见间质性肺炎（UIP）的预测的具体特征，并确定预测活检一致性的临床指标。COLDICE 研究是一项前瞻性、多中心研究，调查了 TBLC 与 SLB 之间的诊断一致性。参与者接受了这两种程序，标本由盲法病理学家进行分析，应用国际指南标准。分析了 TBLC 对配对 SLB 中 UIP 的预测特征和总体一致性的预测特征。共有 65 名患者（66.1±9.3 岁；FVC，84.7±14.2%；Dl，63.4±13.8%）参加了 COLDICE 研究。33/65（50.8%）的 SLB 中发现 UIP，81.5%与相应的 TBLC 一致（κ，0.61；95%置信区间[CI]，0.38-0.77）。TBLC 中很少报告 UIP 指南标准的“主要位于胸膜下或分隔旁纤维化”（8/33，24.2%），而“斑片状纤维化”、“成纤维细胞灶”和“无其他诊断特征”在 TBLC 中经常观察到。这三个特征的结合强烈预测了配对 SLB 中的 UIP（比值比[OR]，23.4；95%CI，6.36-86.1； < 0.0001）。TBLC 样本数量的增加预测了与 SLB 的组织病理学一致性（OR，1.8；95%CI，1.08-3.01； = 0.03）。不一致的预测因素包括年龄较大、家族史和影像学不对称。TBLC 中，只要存在其他指南标准特征，胸膜下和/或分隔旁纤维化并非诊断 UIP 的必要条件。增加样本数量可增强 TBLC 的诊断准确性。这项临床试验已在 www.anzctr.org.au（ACTRN12615000718549）注册。
