Park Jin Han, Jang Ji Hoon, Kim Hyun Kuk, Jang Hang-Jea, Lee Sunggun, Kim Seong-Ho, Kim Ji Yeon, Choi Hee Eun, Han Ji-Yeon, Kim Da Som, Kang Min Kyun, Kang Eunsu, Kim Il Hwan, Lee Jae Ha
Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
Tuberc Respir Dis (Seoul). 2022 Oct;85(4):341-348. doi: 10.4046/trd.2022.0031. Epub 2022 Aug 2.
An accurate diagnosis in patients with interstitial lung diseases (ILDs) by multidisciplinary discussion (MDD) based on histopathologic information is essential for optimal treatment. Transbronchial lung cryobiopsy (TBLC) has increasingly been used as a diagnostic alternative to surgical lung biopsy. This study aimed to evaluate the appropriate methods of TBLC in patients with ILD in Korea.
A total of 27 patients who underwent TBLC were included. TBLC procedure details and clinical MDD diagnosis using TBLC histopathologic information were retrospectively analyzed.
All procedures were performed under general anesthesia with the fluoroscopic guidance in the operation room using flexible bronchoscopy and endobronchial balloon blocker. The median procedure duration was less than 30 minutes, and the median number of biopsies per participant was 2. Most of the bleeding after TBLC was not severe, and the rate of pneumothorax was 25.9%. The most common histopathologic pattern was alternative (48.2%), followed by indeterminate (33.3%) and usual interstitial pneumonia (UIP)/probable UIP (18.5%). In the MDD after TBLC, the most common diagnosis was idiopathic pulmonary fibrosis (33.3%), followed by smoking-related ILD (25.9%), nonspecific interstitial pneumonia (18.6%), unclassifiable-ILD (14.8%), and others (7.4%).
This first single-center experience showed that TBLC using a flexible bronchoscopy and endobronchial balloon blocker with the fluoroscopic guidance under general anesthesia may be a safe and adequate diagnostic method for ILD patients in Korea. The diagnostic yield of MDD was 85.2%. Further studies are needed to evaluate the diagnostic yield and confidence of TBLC.
基于组织病理学信息通过多学科讨论（MDD）对间质性肺疾病（ILDs）患者进行准确诊断对于优化治疗至关重要。经支气管肺冷冻活检（TBLC）已越来越多地被用作外科肺活检的替代诊断方法。本研究旨在评估韩国ILD患者中TBLC的合适方法。
共纳入27例行TBLC的患者。回顾性分析TBLC操作细节以及使用TBLC组织病理学信息进行的临床MDD诊断。
所有操作均在手术室全身麻醉下，使用可弯曲支气管镜和支气管内球囊封堵器并在荧光透视引导下进行。操作的中位持续时间少于30分钟，每位参与者的活检中位次数为2次。TBLC术后大多数出血不严重，气胸发生率为25.9%。最常见的组织病理学模式是交替性（48.2%），其次是不确定型（33.3%）和普通间质性肺炎（UIP）/可能的UIP（18.5%）。在TBLC后的MDD中，最常见的诊断是特发性肺纤维化（33.3%），其次是吸烟相关的ILD（25.9%）、非特异性间质性肺炎（18.6%）、无法分类的ILD（14.8%）和其他（7.4%）。
这第一项单中心经验表明，在全身麻醉下使用可弯曲支气管镜和支气管内球囊封堵器并在荧光透视引导下进行TBLC，对于韩国ILD患者可能是一种安全且充分的诊断方法。MDD的诊断率为85.2%。需要进一步研究来评估TBLC的诊断率和可信度。
