State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,
Department of Pulmonary and Critical Care Medicine, Huizhou Municipal Central Hospital, Huizhou, China.
Respiration. 2022;101(3):299-306. doi: 10.1159/000519502. Epub 2021 Nov 1.
Transbronchial cryobiopsy (TBCB) is increasingly being identified as a potential alternative for the diagnosis of interstitial lung disease (ILD). The specimen size of TBCB is positively related to the freezing time. However, the proper initial freezing time for the clinical application of TBCB in ILD remains unknown.
A prospective randomized parallel group study was employed to investigate ILD patients with unclear diagnosis, who were admitted to the First Affiliated Hospital of Guangzhou Medical University from May 2019 to October 2020 and required TBCB. All patients were randomly divided into 4 groups according to the different freezing times of TBCB: 3 s, 4 s, 5 s, and 6 s groups. All operations were performed under intravenous anesthesia with endotracheal intubation, 60-65 bar pressure of freezing gas source, and 1.9-mm cryoprobe. Compare differences among groups in specimen size, complications, pathological diagnosis efficiency, and multidisciplinary discussion (MDD) diagnostic efficiency.
A total of 100 patients were recruited and randomly assigned into 4 groups (n = 25 each group). The specimen sizes of TBCB in ILD were positively correlated with the freezing time (r = 0.639, p < 0.05). None of the patients experienced Grade 3 severe bleeding. Pneumothorax occurred in 1 patient in the 4 s, 5 s, and 6 s groups, respectively. The diagnostic yield of MDD in the 3 s, 4 s, 5 s, and 6 s groups were 64%, 88%, 88%, and 96%, respectively (p < 0.05), but showing no significant differences among 4 s, 5 s, and 6 s groups.
The specimen size and diagnostic efficiency of TBCB in ILD increased with a longer freezing time. When the freezing gas pressure is 60-65 bar, we recommended 4 s as the initial freezing time of TBCB, and this time is associated with high diagnostic efficiency and low incidence of complications.
经支气管冷冻活检（TBCB）作为一种诊断间质性肺疾病（ILD）的潜在方法，其应用日益增多。TBCB 的标本大小与冷冻时间呈正相关。然而，TBCB 在ILD 中的临床应用的初始适当冷冻时间仍不清楚。
采用前瞻性随机平行分组研究，纳入 2019 年 5 月至 2020 年 10 月在广州医科大学附属第一医院因诊断不明而需要 TBCB 的ILD 患者。所有患者根据 TBCB 的不同冷冻时间随机分为 4 组：3 s、4 s、5 s 和 6 s 组。所有操作均在静脉麻醉下经气管插管进行，冷冻气源压力为 60-65 巴，使用 1.9-mm 冷冻探针。比较各组间标本大小、并发症、病理诊断效率和多学科讨论（MDD）诊断效率的差异。
共纳入 100 例患者，随机分为 4 组（每组 25 例）。ILD 患者 TBCB 的标本大小与冷冻时间呈正相关（r = 0.639，p < 0.05）。无患者发生 3 级严重出血。4 s、5 s 和 6 s 组各有 1 例患者发生气胸。3 s、4 s、5 s 和 6 s 组的 MDD 诊断率分别为 64%、88%、88%和 96%（p < 0.05），但 4 s、5 s 和 6 s 组之间无显著差异。
ILD 患者 TBCB 的标本大小和诊断效率随冷冻时间的延长而增加。当冷冻气压为 60-65 巴时，我们推荐 4 s 作为 TBCB 的初始冷冻时间，该时间与高诊断效率和低并发症发生率相关。
