Division of Pulmonary, Critical Care, and Sleep Medicine.
Division of Pulmonary and Critical Care, University Hospitals, Case Western Reserve University, Cleveland, OH.
J Bronchology Interv Pulmonol. 2023 Apr 1;30(2):99-113. doi: 10.1097/LBR.0000000000000865.
Diagnosis of interstitial lung disease (ILD) is based on multidisciplinary team discussion (MDD) with the incorporation of clinical, radiographical, and histopathologic information if available. We aim to evaluate the diagnostic yield and safety outcomes of transbronchial lung cryobiopsy (TBLC) in the diagnosis of ILD.
We conducted a meta-analysis by comprehensive literature search to include all studies that evaluated the diagnostic yields and/or adverse events with TBLC in patients with ILD. We calculated the pooled event rates and their 95% confidence intervals (CIs) for the diagnostic yield by MDD, histopathologic diagnostic yield, and various clinical adverse events.
We included 68 articles (44 full texts and 24 abstracts) totaling 6386 patients with a mean age of 60.7±14.1 years and 56% men. The overall diagnostic yield of TBLC to achieve a definite or high-confidence diagnosis based on MDD was 82.3% (95% CI: 78.9%-85.2%) and histopathologic diagnosis of 72.5% (95% CI: 67.7%-76.9%). The overall rate of pneumothorax was 9.6% (95% CI: 7.9%-11%), while the rate of pneumothorax requiring drainage by a thoracostomy tube was 5.3% (95% CI: 4.1%-6.9%). The rate of moderate bleeding was 11.7% (95% CI: 9.1%-14.9%), while the rate of severe bleeding was 1.9% (95% CI: 1.4%-2.6%). The risk of mortality attributed to the procedure was 0.9% (95% CI: 0.7%-1.3%).
Among patients with undiagnosed or unclassified ILD requiring tissue biopsy for diagnosis, transbronchial cryobiopsy represents a reliable alternative to surgical lung biopsy with decreased incidence of various clinical adverse events.
间质性肺疾病（ILD）的诊断基于多学科团队讨论（MDD），并结合临床、影像学和组织病理学信息（如果有）。我们旨在评估经支气管肺冷冻活检（TBLC）在ILD 诊断中的诊断收益和安全性结果。
我们通过全面的文献检索进行了荟萃分析，纳入了所有评估 TBLC 在 ILD 患者中的诊断收益和/或不良事件的研究。我们计算了 MDD、组织病理学诊断收益以及各种临床不良事件的诊断收益的合并事件发生率及其 95%置信区间（CI）。
我们纳入了 68 篇文章（44 篇全文和 24 篇摘要），共计 6386 名患者，平均年龄为 60.7±14.1 岁，56%为男性。基于 MDD 得出明确或高度置信诊断的 TBLC 总体诊断收益为 82.3%（95%CI：78.9%-85.2%），组织病理学诊断收益为 72.5%（95%CI：67.7%-76.9%）。总的气胸发生率为 9.6%（95%CI：7.9%-11%），需要胸腔引流的气胸发生率为 5.3%（95%CI：4.1%-6.9%）。中等程度出血的发生率为 11.7%（95%CI：9.1%-14.9%），严重出血的发生率为 1.9%（95%CI：1.4%-2.6%）。归因于该程序的死亡率为 0.9%（95%CI：0.7%-1.3%）。
在需要组织活检进行诊断的未确诊或未分类的 ILD 患者中，经支气管肺冷冻活检是一种可靠的替代手术肺活检的方法，可降低各种临床不良事件的发生率。
