Respiratory Center of the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China.
Department of Pathology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China.
Respiration. 2023;102(10):891-898. doi: 10.1159/000533868. Epub 2023 Sep 27.
Confocal laser endomicroscopy (CLE) has the characteristics of high resolution, real-time imaging, and no radiation, which is helpful for the precise and effective implementation of transbronchial cryobiopsy (TBCB). The study aimed to compare the efficacy and safety of TBCB combined with CLE (CLE group) or fluoroscopy (fluoroscopy group) in the diagnosis of interstitial lung disease (ILD).
From a prospective randomized controlled trial, 80 patients with undiagnosed ILD or ILD requiring biopsy between January 2022 and November 2022 were randomly assigned to CLE group and fluoroscopy group. The rate to reach an etiological diagnosis of ILD, maximum cross-sectional area of specimens, operation time, and complications were compared between the two groups.
The rate to reach an etiological diagnosis in the CLE group was significantly higher than that in the fluoroscopy group (95.0% vs. 80.0%, p < 0.05), but there was no difference in the maximum cross-sectional area of the specimens (42.1 ± 10.1 mm2 vs. 41.5 ± 10.3 mm2, p > 0.05). In terms of operation time, the CLE group was significantly shorter than the fluoroscopy group (37.6 ± 10.6 min vs. 54.8 ± 24.9 min, p < 0.05). The bleeding volume in the CLE group was significantly lower than that in the fluoroscopy group (4.9 ± 3.6 mL/case vs. 9.0 ± 9.2 mL/case, p < 0.05). Further analysis showed that the incidence of moderate bleeding was also lower in the CLE group (20.0% vs. 75.0%, p < 0.001). In addition, the incidence of pneumothorax in the CLE group was significantly lower than that in the fluoroscopy group (0 vs. 25.0%, p < 0.001).
Compared with simple fluoroscopy, the combination of CLE significantly improves the rate of etiological diagnosis, shortens the operation time, and reduces complications such as bleeding and pneumothorax.
共聚焦激光内镜（CLE）具有高分辨率、实时成像和无辐射的特点，有助于对经支气管冷冻活检（TBCB）进行精确、有效的实施。本研究旨在比较 TBCB 联合 CLE（CLE 组）或透视（透视组）在诊断间质性肺疾病（ILD）方面的疗效和安全性。
从 2022 年 1 月至 2022 年 11 月进行的一项前瞻性随机对照试验中，将 80 例未确诊的 ILD 或需要活检的 ILD 患者随机分为 CLE 组和透视组。比较两组 ILD 的病因诊断率、标本最大横截面积、手术时间和并发症。
CLE 组达到病因诊断的比例明显高于透视组（95.0%比 80.0%，p < 0.05），但标本最大横截面积无差异（42.1 ± 10.1 mm2 比 41.5 ± 10.3 mm2，p > 0.05）。在手术时间方面，CLE 组明显短于透视组（37.6 ± 10.6 min 比 54.8 ± 24.9 min，p < 0.05）。CLE 组的出血量明显低于透视组（4.9 ± 3.6 mL/例比 9.0 ± 9.2 mL/例，p < 0.05）。进一步分析显示，CLE 组中度出血的发生率也较低（20.0%比 75.0%，p < 0.001）。此外，CLE 组气胸的发生率明显低于透视组（0 比 25.0%，p < 0.001）。
与单纯透视相比，CLE 联合应用可显著提高病因诊断率，缩短手术时间，并减少出血和气胸等并发症。
