Center of Excellence for Interstitial Lung Diseases, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel,
Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel,
Respiration. 2023;102(9):852-860. doi: 10.1159/000533197. Epub 2023 Aug 25.
Interstitial lung disease (ILD) evaluation often requires lung biopsy for definite diagnosis. In recent years, transbronchial cryobiopsy (TBCB) emerged as a procedure with higher diagnostic yield than transbronchial forceps biopsy (TBFB), especially for fibrotic ILDs. Nonetheless, studies comparing these modalities in non-fibrotic ILDs and for specific ILD diagnoses are scarce.
The aim of this study was to evaluate the diagnostic yield and safety of TBCB and TBFB in patients with fibrotic and non-fibrotic ILDs.
An observational retrospective multicenter study including patients with ILD diagnosis by multidisciplinary discussion that underwent TBCB or TBFB between 2017 and 2021. Chest CT scans were reviewed by a chest radiologist. Biopsy specimens were categorized as diagnostic (with specific histological pattern), nondiagnostic, or without lung parenchyma. Nondiagnostic samples were reassessed by a second lung pathologist. TBCB and TBFB diagnostic yields were analyzed by multivariate regression. Procedural complications were evaluated as well.
276 patients were included, 116 (42%) underwent TBCB and 160 (58%) TBFB. Fibrotic ILDs were present in 148 patients (54%). TBCB diagnostic yield was 78% and TBFB 48% (adjusted odds ratio [AOR] 4.2, 95% CI: 2.4-7.6, p < 0.01). The diagnostic yield of TBCB was higher than TBFB among patients with fibrotic ILD (AOR 3.8, p < 0.01), non-fibrotic ILD (AOR 5.8, p < 0.01), and across most ILD diagnoses. TBCB was associated with higher risk for significant bleeding (10% vs. 3%, p < 0.01), but similar risk for pneumothorax.
Diagnostic yield of TBCB was superior to that of TBFB for both fibrotic and non-fibrotic ILDs, and across most diagnoses.
间质性肺疾病（ILD）的评估常需要进行肺活检以明确诊断。近年来，经支气管冷冻活检（TBCB）作为一种比经支气管钳活检（TBFB）诊断率更高的方法出现，尤其是在纤维化的ILD 中。然而，比较这两种方法在非纤维化的ILD 中的应用以及在特定的ILD 诊断中的研究仍然很少。
本研究旨在评估 TBCB 和 TBFB 在纤维化和非纤维化 ILD 患者中的诊断率和安全性。
这是一项观察性回顾性多中心研究，纳入了 2017 年至 2021 年间经多学科讨论诊断为 ILD 并接受 TBCB 或 TBFB 检查的患者。胸部 CT 扫描由胸部放射科医生进行评估。活检标本分为有诊断意义（有特定的组织学模式）、无诊断意义和无肺实质。无诊断意义的标本由第二位肺病理学家进行重新评估。通过多变量回归分析 TBCB 和 TBFB 的诊断率。还评估了操作相关并发症。
共纳入 276 例患者，116 例（42%）接受了 TBCB 检查，160 例（58%）接受了 TBFB 检查。148 例（54%）患者存在纤维化的 ILD。TBCB 的诊断率为 78%，TBFB 为 48%（调整后的优势比[OR]为 4.2，95%CI：2.4-7.6，p < 0.01）。在纤维化 ILD 患者（OR 3.8，p < 0.01）、非纤维化 ILD 患者（OR 5.8，p < 0.01）以及大多数 ILD 诊断中，TBCB 的诊断率均高于 TBFB。TBCB 与显著出血（10% vs. 3%，p < 0.01）的风险增加相关，但气胸的风险相似。
TBCB 在纤维化和非纤维化 ILD 以及大多数诊断中均优于 TBFB。
