Han Sung Joon, Chung Chaeuk, Park Dongil
Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Daejeon, South Korea.
Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea.
Diagn Pathol. 2025 Apr 11;20(1):42. doi: 10.1186/s13000-025-01644-z.
Non-tuberculous mycobacterial (NTM) lung disease presents diagnostic and therapeutic challenges, often mimicking lung cancer, tuberculosis, and other bronchopulmonary disorders. Management typically involves prolonged antibiotic treatment, but alternative therapeutic approaches for localized disease remain underexplored. Cryobiopsy has emerged as an advanced bronchoscopic diagnostic technique, providing larger, higher-quality lung tissue samples compared to traditional forceps biopsy. However, its potential therapeutic effects, particularly its unintended cryoablation effect, remain an area of active investigation.
A 46-year-old healthy woman was incidentally found to have a 1.3-cm pulmonary nodule in the left anterior basal segment during a routine health examination, with no symptoms or significant medical history. Initial CT imaging raised suspicions of T1a lung cancer. Subsequent endobronchial ultrasound transbronchial lung biopsy and transbronchial lung cryobiopsy revealed granulomatous inflammation. Tests for tuberculosis and NTM, including acid-fast bacilli (AFB) smear, mycobacterial culture, and PCR for Mycobacterium tuberculosis and NTM, were negative. Following the biopsies, chest X-rays showed an enlarged shadow at the lesion, suggesting necrosis after cryobiopsy. The patient was treated with moxifloxacin, leading to symptom improvement. A final diagnosis of NTM infection, specifically Mycobacterium avium, was confirmed from bronchoalveolar lavage fluid obtained three weeks after the tissue biopsy. Remarkably, at four months post-biopsy, a chest CT scan showed complete resolution of the nodule without additional antimicrobial therapy, suggesting a potential therapeutic effect of cryobiopsy-induced cryoablation.
NTM nodules may undergo necrosis and resolve due to the ablation effect of cryobiopsy, suggesting cryoablation as a potential option for inoperable localized NTM disease.
非结核分枝杆菌（NTM）肺病在诊断和治疗方面存在挑战，常与肺癌、肺结核及其他支气管肺部疾病相似。其治疗通常需要长期使用抗生素，但针对局限性疾病的替代治疗方法仍未得到充分探索。冷冻活检已成为一种先进的支气管镜诊断技术，与传统钳取活检相比，能提供更大、质量更高的肺组织样本。然而，其潜在的治疗效果，尤其是意外的冷冻消融效果，仍是一个积极研究的领域。
一名46岁健康女性在常规健康检查中偶然发现左前基底段有一个1.3厘米的肺结节，无症状且无重大病史。最初的CT影像怀疑为T1a期肺癌。随后的支气管内超声引导下经支气管肺活检和经支气管肺冷冻活检显示为肉芽肿性炎症。结核和NTM检测，包括抗酸杆菌（AFB）涂片、分枝杆菌培养以及结核分枝杆菌和NTM的PCR检测均为阴性。活检后，胸部X线显示病变处阴影增大，提示冷冻活检后出现坏死。患者接受莫西沙星治疗后症状改善。在组织活检三周后获取的支气管肺泡灌洗液中确诊为NTM感染，具体为鸟分枝杆菌。值得注意的是，活检后四个月，胸部CT扫描显示结节完全消退，无需额外的抗菌治疗，提示冷冻活检诱导的冷冻消融可能具有治疗作用。
NTM结节可能因冷冻活检的消融作用而发生坏死并消退，提示冷冻消融作为无法手术的局限性NTM疾病的一种潜在选择。
