Dept of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Pulmonary Unit, "G. Mazzini" Hospital, Teramo, Italy.
Eur Respir J. 2022 Nov 10;60(5). doi: 10.1183/13993003.00425-2022. Print 2022 Nov.
In patients with interstitial lung diseases (ILD), histopathological input is often required to obtain a diagnosis. Surgical lung biopsy (SLB) is considered the reference standard, but many patients are clinically unfit to undergo this invasive procedure, and adverse events, length of hospitalisation and costs are considerable. This European Respiratory Society (ERS) guideline provides evidence-based clinical practice recommendations for the role of transbronchial lung cryobiopsy (TBLC) in obtaining tissue-based diagnosis in patients with undiagnosed ILD.
The ERS Task Force consisted of clinical experts in the field of ILD and/or TBLC and methodological experts. Four PICO (Patient, Intervention, Comparator, Outcomes) questions and two narrative questions were formulated. Systematic literature searches were performed in MEDLINE and Embase (up to June 2021). GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology was applied.
In patients with undiagnosed ILD and an indication to obtain histopathological data: 1) TBLC is suggested as a replacement test in patients considered eligible to undergo SLB, 2) TBLC is suggested in patients not considered eligible to undergo SLB, 3) SLB is suggested as an add-on test in patients with a non-informative TBLC, 4) no recommendation is made for or against a second TBLC in patients with a non-informative TBLC and 5) TBLC operators should undergo training, but no recommendation is made for the type of training required.
TBLC provides important diagnostic information in patients with undiagnosed ILD. Diagnostic yield is lower compared to SLB, at reduced serious adverse events and length of hospitalisation. Certainty of the evidence is mostly "very low".
在患有间质性肺疾病（ILD）的患者中，通常需要组织病理学检查来获得诊断。外科肺活检（SLB）被认为是金标准，但许多患者因临床原因无法进行这种有创性检查，且不良事件、住院时间和费用都相当可观。本欧洲呼吸学会（ERS）指南提供了基于证据的临床实践建议，以确定经支气管肺冷冻活检（TBLC）在获取未经诊断的ILD 患者基于组织的诊断中的作用。
ERS 工作组由ILD 领域和/或 TBLC 领域的临床专家以及方法学专家组成。制定了 4 个 PICO（患者、干预、比较、结局）问题和 2 个叙述性问题。在 MEDLINE 和 Embase 中进行了系统的文献检索（截至 2021 年 6 月）。应用 GRADE（分级、推荐、评估、发展和评价）方法。
在患有未经诊断的ILD 且有获取组织病理学数据指征的患者中：1）TBLC 被建议作为有资格接受 SLB 的患者的替代检查；2）TBLC 被建议用于不适合接受 SLB 的患者；3）TBLC 被建议用于非信息性 TBLC 的患者；4）对于非信息性 TBLC 的患者，不推荐进行第二次 TBLC；5）TBLC 操作者应接受培训，但对于所需的培训类型未作推荐。
TBLC 为未经诊断的ILD 患者提供了重要的诊断信息。与 SLB 相比，TBLC 的诊断效果较低，但严重不良事件和住院时间较短。证据的确定性主要为“极低”。
