Unit of Thoracic Surgery, Cardio-Vascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.
Unit of Pulmonology, Cardio-Vascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.
Minerva Surg. 2024 Apr;79(2):133-139. doi: 10.23736/S2724-5691.23.09948-3. Epub 2023 May 23.
According to current guidelines, a surgical biopsy is rarely required when a high-confidence radiologic interstitial lung disease (ILD) diagnosis is made on thin-section high-resolution computed tomography (HRCT). Nevertheless, disowning HRCT scans diagnosed by biopsy are more common than presumed. Our study aimed to describe the concordance rate between HRCT scans and pathological diagnoses of ILDs obtained by surgical biopsy. The current guideline suggests the use of surgical lung biopsy (SLB) in patients with newly detected ILD of unknown cause.
Patients who underwent mini-invasive surgical biopsies for interstitial lung diseases from January 2018 to August 2022 were analyzed. The HRCT scans were reviewed by an observer blinded to the patient's clinical information. The concordance between histological and HRCT-scan were assessed.
Data from 104 patients with uncertain low confidence diagnosis of interstitial lung diseases at HRCT were analyzed. Most of the patients are male (65; 62.5%). The more frequent HRCT pattern were: alternative diagnoses (46; 44.23%), UIP probable (42; 40.38%), UIP indeterminate (7; 6.73%), and non-specific interstitial pneumonia (NSIP) (9, 8.65%). The more common histological diagnosis was UIP definite (30; 28.84%), hypersensitivity pneumonia [HP](19; 18.44%), NSIP (15; 14.42%), sarcoidosis (10; 9.60%). In 7 (20%) cases, the final pathological finding denies HRCT-scans diagnoses; indeed, a moderate agreement was observed between HRCT-scan findings and the definitive histological diagnosis (kappa index: 0.428).
HRCT-scan has limitations if the objective is to define interstitial lung diseases accurately. Consequently, pathological assessment should be taken into account in order to provide more accurate tailored treatment strategies because the risk is to wait from 12 to 24 months to ascertain if the ILD will be treatable as progressive pulmonary fibrosis (PPF). Undeniably true, video-assisted surgical lung biopsy (VASLB) with endotracheal intubation and mechanical ventilation is associated with a risk of mortality and morbidity that is far from nil. Nevertheless, in recent years a VASLB approach performed in awake subjects under loco-regional anesthesia (awake-VASLB) has been suggested as an effective method to obtain a highly confident diagnosis in patients with diffuse pathologies of the lung parenchyma.
根据目前的指南，当在高分辨率 CT（HRCT）上进行高可信度的间质性肺病（ILD）诊断时，很少需要进行外科活检。然而，活检否认 HRCT 扫描的情况比预想的更为常见。我们的研究旨在描述 HRCT 扫描与通过外科活检获得的间质性肺病的病理诊断之间的一致性率。目前的指南建议对新发现的ILD 病因不明的患者使用外科肺活检（SLB）。
分析了 2018 年 1 月至 2022 年 8 月间因间质性肺病进行微创外科活检的患者。对 HRCT 扫描进行了分析，观察者对患者的临床信息不知情。评估了组织学和 HRCT 扫描之间的一致性。
分析了 104 例 HRCT 不确定低度置信度诊断的间质性肺病患者的数据。大多数患者为男性（65 例；62.5%）。更常见的 HRCT 模式为：其他诊断（46 例；44.23%）、UIP 可能（42 例；40.38%）、UIP 不确定（7 例；6.73%）和非特异性间质性肺炎（NSIP）（9 例；8.65%）。更常见的组织学诊断为 UIP 明确（30 例；28.84%）、过敏性肺炎[HP]（19 例；18.44%）、NSIP（15 例；14.42%）、结节病（10 例；9.60%）。在 7 例（20%）病例中，最终病理发现否认 HRCT 扫描诊断；事实上，HRCT 扫描发现与明确的组织学诊断之间存在中度一致性（kappa 指数：0.428）。
如果目的是准确界定间质性肺病，HRCT 扫描有其局限性。因此，为了提供更准确的靶向治疗策略，应考虑病理评估，因为风险是等待 12 至 24 个月以确定ILD 是否可作为进行性肺纤维化（PPF）进行治疗。诚然，气管内插管和机械通气的电视辅助外科肺活检（VASLB）与死亡率和发病率相关，风险并非微不足道。然而，近年来，有人提出在局部麻醉下进行清醒状态下的 VASLB（清醒-VASLB）作为一种有效的方法，可在弥漫性肺实质疾病患者中获得高度可信的诊断。
