Royal Brompton and Harefield Hospitals, London, UK.
Guy's and St Thomas' Hospitals NHS Trust, London, UK.
Respirology. 2024 Jun;29(6):489-496. doi: 10.1111/resp.14678. Epub 2024 Feb 14.
Bronchoscopic transbronchial lung cryobiopsy (TBLC) is a guideline-endorsed alternative to surgical lung biopsy for tissue diagnosis in unclassifiable interstitial lung disease (ILD). The reported incidence of post-procedural bleeding has varied widely. We aimed to characterize the incidence, severity and risk factors for clinically significant bleeding following TBLC using an expert-consensus airway bleeding scale, in addition to other complications and diagnostic yield.
A retrospective cohort study of consecutive adult outpatients with unclassifiable ILD who underwent TBLC following multidisciplinary discussion at a single centre in the UK between July 2016 and December 2021. TBLC was performed under general anaesthesia with fluoroscopic guidance and a prophylactic endobronchial balloon.
One hundred twenty-six patients underwent TBLC (68.3% male; mean age 62.7 years; FVC 86.2%; DLCO 54.5%). Significant bleeding requiring balloon blocker reinflation for >20 min, admission to ICU, packed red blood cell transfusion, bronchial artery embolization, resuscitation or procedural abandonment, occurred in 10 cases (7.9%). Significant bleeding was associated with traction bronchiectasis on HRCT (OR 7.1, CI 1.1-59.1, p = 0.042), a TBLC histological pattern of UIP (OR 4.0, CI 1.1-14, p = 0.046) and the presence of medium-large vessels on histology (OR 37.3, CI 6.5-212, p < 0.001). BMI ≥30 (p = 0.017) and traction bronchiectasis on HRCT (p = 0.025) were significant multivariate predictors of longer total bleeding time (p = 0.017). Pneumothorax occurred in nine cases (7.1%) and the 30-day mortality was 0%. Diagnostic yield was 80.6%.
TBLC has an acceptable safety profile in experienced hands. Radiological traction bronchiectasis and obesity increase the risk of significant bleeding following TBLC.
经支气管镜透壁肺冷冻活检（TBLC）是指南推荐的替代方法，用于对无法分类的间质性肺疾病（ILD）进行组织诊断。术后出血的报告发生率差异很大。我们旨在使用专家共识气道出血量表来描述 TBLC 后临床显著出血的发生率、严重程度和危险因素，以及其他并发症和诊断率。
这是一项回顾性队列研究，纳入了 2016 年 7 月至 2021 年 12 月期间在英国一家中心接受多学科讨论后行 TBLC 的连续成年ILD 门诊患者。TBLC 在全身麻醉下进行，采用透视引导和预防性支气管内球囊。
126 例患者接受了 TBLC（68.3%为男性；平均年龄 62.7 岁；FVC 86.2%；DLCO 54.5%）。10 例（7.9%）出现需要球囊阻塞器再充气>20 分钟、入住 ICU、输红细胞、支气管动脉栓塞、复苏或放弃操作的临床显著出血。HRCT 上存在牵引性支气管扩张（OR 7.1，CI 1.1-59.1，p=0.042）、TBLC 组织学表现为 UIP（OR 4.0，CI 1.1-14，p=0.046）和组织学上存在中大型血管（OR 37.3，CI 6.5-212，p<0.001）与临床显著出血相关。BMI≥30（p=0.017）和 HRCT 上存在牵引性支气管扩张（p=0.025）是总出血时间较长的显著多变量预测因素（p=0.017）。9 例（7.1%）发生气胸，30 天死亡率为 0%。诊断率为 80.6%。
在有经验的医生手中，TBLC 具有可接受的安全性。影像学上的牵引性支气管扩张和肥胖增加了 TBLC 后发生临床显著出血的风险。
