Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.
Department of Respiratory Medicine, South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Kloevervaenget 2, 5000, Odense C, Denmark.
BMC Pulm Med. 2021 Feb 25;21(1):67. doi: 10.1186/s12890-021-01438-1.
BACKGROUND: Transbronchial lung cryobiopsy (TBLC) has been introduced as an alternative to surgical lung biopsy (SLB) in the diagnostics of interstitial lung diseases (ILD). Despite controversy on safety, TBLC is increasingly implemented in ILD centers with an apparent diagnostic yield comparable to SLB. The aim of this study was to assess TBLC implementation experiences from a tertiary Danish ILD center regarding diagnosis, complications, and learning curves for TBLC performance. METHODS: TBLC was prospectively performed in a cohort of patients with unclassifiable ILD based on a preceding multidisciplinary clinical and radiological revision. TBLC was performed as an outpatient procedure with the patients in general anesthesia using a flexible bronchoscope with 1.9 or 2.4 mm cryoprobes. Learning curves for TBLC performance were calculated using cumulated sum (CUSUM) scores for diagnostic yield, pneumothorax, and bleeding. RESULTS: From February 2017 to March 2020 141 patients (86 (61%) men, median age 69 years [IQR, 60-74 years]) had TBLC performed. A histological and confirmative diagnosis was made in 101 patients (75.2%) and 124 patients (87.9%, i.e. clinical diagnostic yield), respectively, in whom idiopathic interstitial pneumonias constituted the majority (67.3%) of the clinical diagnoses. We observed 2 deaths (1.4%) within 30 days of TBLC, but no procedure-related mortality or severe bleeding. Moderate bleeding occurred in 23 patients (16.3%), pneumothorax in 21 patients (14.9%) with only 14 patients (9.9%) requiring a pleural drain. Based on the CUSUM score analysis, the diagnostic yield obtained was satisfactory throughout the period. CONCLUSION: This study reports experiences of outpatient TBLC implementation in a tertiary referral ILD center from the largest investigated TBLC cohort in Scandinavia The diagnostic yield and prevalence of complications obtained by TBLC from this single center study on unclassifiable ILD support outpatient TBLC as a valuable and safe alternative to SLB to diagnose ILD in well-selected patients. The learning curves for TBLC were acceptable in the hands of experienced bronchoscopists.
背景：经支气管肺冷冻活检（TBLC）已作为外科肺活检（SLB）的替代方法引入到间质性肺疾病（ILD）的诊断中。尽管关于安全性存在争议，但 TBLC 已在ILD 中心得到越来越多的应用，其诊断率与 SLB 相当。本研究旨在评估丹麦一家三级ILD 中心实施 TBLC 的经验，包括诊断、并发症以及 TBLC 操作的学习曲线。
方法：对先前经过多学科临床和影像学修订后仍无法分类的ILD 患者进行前瞻性 TBLC 检查。TBLC 作为一项门诊程序，在全身麻醉下使用 1.9 或 2.4mm 冷冻探针通过柔性支气管镜进行。使用累积和（CUSUM）评分计算 TBLC 操作的诊断率、气胸和出血的学习曲线。
结果：从 2017 年 2 月至 2020 年 3 月，共对 141 例患者（86 例[61%]男性，中位年龄 69 岁[IQR，60-74 岁]）进行了 TBLC。101 例（75.2%）和 124 例（87.9%，即临床诊断率）患者进行了组织学和确诊诊断，其中特发性间质性肺炎构成大多数（67.3%）的临床诊断。我们观察到 2 例（1.4%）患者在 TBLC 后 30 天内死亡，但无与操作相关的死亡率或严重出血。23 例（16.3%）患者出现中度出血，21 例（14.9%）患者出现气胸，仅有 14 例（9.9%）患者需要胸腔引流。基于 CUSUM 评分分析，整个研究期间的诊断率均令人满意。
结论：本研究报告了丹麦一家三级转诊ILD 中心开展门诊 TBLC 的经验，这是斯堪的纳维亚地区最大的 TBLC 队列研究。该单中心对无法分类的ILD 患者进行的 TBLC 研究中获得的诊断率和并发症发生率支持将 TBLC 作为 SLB 的一种有价值且安全的替代方法，用于在精心选择的患者中诊断ILD。经验丰富的支气管镜医生在操作 TBLC 时，其学习曲线是可以接受的。
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