Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Clin Chest Med. 2024 Mar;45(1):25-32. doi: 10.1016/j.ccm.2023.08.001. Epub 2023 Dec 18.
Sarcoidosis is a multisystem inflammatory disorder with unclear etiology and can often pose a diagnostic challenge. A tissue diagnosis is often necessary to illustrate the non-caseating granulomas on histopathology. This review aims to synthesize current evidence related to tissue diagnosis of sarcoidosis using various bronchoscopic techniques. We start by discussing standard bronchoscopic techniques which have remained the cornerstone of diagnostic workup such as bronchoalveolar lavage (BAL), endobronchial biopsy (EBB), conventional transbronchial needle aspiration (cTBNA) and transbronchial lung biopsy (TBLB) followed by newer modalities that incorporate real-time image guidance using endobronchial and endoscopic ultrasound. Although BAL, EBB, and TBLB have been employed as a diagnostic tool for several decades, their sensitivity and diagnostic yield is inferior to ultrasound-based endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). More recently, convincing evidence has also emerged to support the diagnostic accuracy and tissue yield of transbronchial lung cryobiopsy which will also be discussed in this review. These advances in bronchoscopic equipment and techniques over the last 2 decades have made it possible to obtain tissue samples using minimally invasive techniques thus avoiding invasive open lung biopsy and the risks that inherently follow. Up-to-date knowledge of these modalities is imperative for ensuring evidence-based medicine and improving patient-centric outcomes.
结节病是一种多系统炎症性疾病，病因不明，常常给诊断带来挑战。组织学诊断通常是必需的，以在组织病理学上显示非干酪样肉芽肿。本综述旨在综合目前使用各种支气管镜技术进行结节病组织诊断的相关证据。我们首先讨论标准支气管镜技术，这些技术仍然是诊断工作的基石，如支气管肺泡灌洗（BAL）、支气管内活检（EBB）、常规经支气管针吸活检（cTBNA）和经支气管肺活检（TBLB），然后介绍结合支气管内和内镜超声实时图像引导的新技术。尽管 BAL、EBB 和 TBLB 已经作为一种诊断工具使用了几十年，但它们的敏感性和诊断率低于基于超声的支气管内超声引导下经支气管针吸活检（EBUS-TBNA）和内镜超声引导下细针抽吸（EUS-FNA）。最近，也有令人信服的证据支持经支气管肺冷冻活检的诊断准确性和组织获取率，这也将在本综述中讨论。过去 20 年来，支气管镜设备和技术的这些进步使得使用微创技术获得组织样本成为可能，从而避免了侵入性的开胸肺活检及其带来的固有风险。了解这些技术的最新进展对于确保循证医学和改善以患者为中心的治疗结果至关重要。
