Zhou Guowu, Ren Yanhong, Li Jun, Yang Ting, Su Nan, Zhao Ling, Wang Shumeng, Wang Dan, Li Ying, Tian Zheng, Liu Ruihong, Dai Huaping, Wang Chen
Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, China.
Department of Pathology, China-Japan Friendship Hospital, Beijing, China.
Front Med (Lausanne). 2022 Aug 2;9:959129. doi: 10.3389/fmed.2022.959129. eCollection 2022.
Transbronchial cryobiopsy (TBCB) is a critical procedure in the diagnosis of interstitial lung diseases (ILD). The associations between high-resolution computed tomography (HRCT) features and outcomes of TBCB were unknown.
This study was conducted as a single-center prospective cohort study between September 2018 and January 2020 (NCT04047667). HRCT was obtained before performing TBCB. The clinical and radiological characteristics, complications, pathological and multidisciplinary discussion (MDD) diagnoses were recorded. The relationships between HRCT features and outcomes of TBCB were analyzed.
TBCB was performed on 216 ILD patients. The radiological features usually interstitial pneumonia (UIP) or probable UIP, indeterminate for UIP, ground-glass opacities (GGO) and cysts were found in 55 (25.5%), 38 (17.6%), 84 (38.9%) and 9 (4.2%) patients, respectively. And 118 (54.6%) patients had high HRCT score (involved lung proportion ≥50%) in the biopsied lobe. Multivariate analysis suggested radiological probable UIP pattern may be an independent risk factor for moderate bleeding (OR = 4.304; 95% CI: 1.383-13.393; = 0.012), while GGO may be a protective factor from moderate bleeding (OR = 0.173, 95% CI: 0.043-0.687; = 0.013). The pathological diagnostic yield in patients presenting cysts on HRCT was significantly lower than others (44.4 vs. 87.9%; = 0.009). While performing TBCB in the lobe with high HRCT score increased pathological diagnostic yield (91.5 vs. 79.6%; = 0.022). Neither pneumothorax nor MDD diagnostic yields were found to be associated with HRCT features.
HRCT features were associated with moderate bleeding and pathological diagnosis. Pre-TBCB assessments of HRCT pattern and scores were helpful for bronchoscopists to make a better patient selection and procedure planning.
经支气管冷冻活检（TBCB）是诊断间质性肺疾病（ILD）的关键操作。高分辨率计算机断层扫描（HRCT）特征与TBCB结果之间的关联尚不清楚。
本研究为2018年9月至2020年1月期间进行的单中心前瞻性队列研究（NCT04047667）。在进行TBCB之前获取HRCT。记录临床和放射学特征、并发症、病理及多学科讨论（MDD）诊断结果。分析HRCT特征与TBCB结果之间的关系。
对216例ILD患者进行了TBCB。放射学特征通常为普通型间质性肺炎（UIP）或可能的UIP、UIP不能确定、磨玻璃影（GGO）和囊肿的患者分别有55例（25.5%）、38例（17.6%）、84例（38.9%）和9例（4.2%）。118例（54.6%）患者活检肺叶的HRCT评分较高（受累肺比例≥50%）。多因素分析表明，放射学上可能的UIP模式可能是中度出血的独立危险因素（OR = 4.304；95%CI：1.383 - 13.393；P = 0.012），而GGO可能是中度出血的保护因素（OR = 0.173，95%CI：0.043 - 0.687；P = 0.013）。HRCT显示有囊肿的患者病理诊断阳性率显著低于其他患者（44.4%对87.9%；P = 0.009）。在HRCT评分较高肺叶进行TBCB可提高病理诊断阳性率（91.5%对79.6%；P = 0.022）。未发现气胸及MDD诊断阳性率与HRCT特征有关。
HRCT特征与中度出血及病理诊断相关。TBCB前对HRCT模式和评分进行评估有助于支气管镜医生更好地进行患者选择和操作规划。
