Tukiainen P, Taskinen E, Korhola O, Valle M
Br J Ind Med. 1978 Nov;35(4):292-304. doi: 10.1136/oem.35.4.292.
A percutaneous needle biopsy was performed with a TruCut needle on 41 patients with suspected pneumoconiosis. Patients selected for biopsy tended to have brief or unusual dust exposure, as well as questionable radiographic opacities. Sixteen had been exposed to asbestos, 13 to silica and 12 to mixed dust containing quartz, coal, iron, asbestos and talc. All patients in the asbestos group and most in the other two groups had a reduced transfer factor. Most patients in the asbestos group and about 25% of the other patients had restrictive ventilatory impairment. Chest radiographs were assessed according to standard films of the ILO U/C International Classification (International Labour Office, 1972). In 25 patients radiographic opacities were absent or acanty (categories 0--1/1). The dominant radiographic feature of many patients exposed to asbestos was a ground-glass appearance or a bilateral elevation of the diaphragm, or both, features difficult to assess according to the ILO U/C scheme. Most histological changes were those usually seen in pneumoconiosis. However, in only two patients with silicosis were silicotic nodules detected. The specimens of seven patients showed a granulomatous inflammation. The severity of alveolar wall involvement correlated well with the transfer factor value but poorly with radiographic changes. The profusion of radiographic opacities also correlated poorly with functional impairment. As a diagnostic tool the needle biopsy was valuable in asbestosis and slightly less so in mixed-dust fibrosis. The biopsy specimens showed changes compatible with asbestosis in 75% of the suspected cases and in 86% of those in which asbestosis was the final diagnosis. In the mixed-dust group pneumoconiosis was confirmed in 67% and 80%, respectively. In the diagnosis of silicosis an open biopsy is probably more reliable than a percutaneous one, particularly if radiographic changes are minimal. Histological changes in the needle biopsy specimen were compatible with silicosis in only 36% of the suspected cases and in 63% of those in which the final diagnosis was silicosis.
对41例疑似尘肺病患者使用TruCut穿刺针进行经皮穿刺活检。入选活检的患者往往有短暂或不寻常的粉尘接触史，以及影像学表现可疑。其中16例曾接触石棉，13例接触二氧化硅，12例接触含石英、煤、铁、石棉和滑石的混合粉尘。石棉组所有患者及其他两组多数患者的肺弥散功能降低。石棉组多数患者及其他组约25%的患者存在限制性通气功能障碍。胸部X线片根据国际劳工组织（ILO）U/C国际分类标准片（国际劳工局，1972年）进行评估。25例患者的X线片表现正常或仅有少量阴影（0-1/1类）。许多接触石棉患者的主要X线特征是磨玻璃样改变或双侧膈肌抬高，或两者兼有，这些特征根据ILO U/C分类法难以评估。多数组织学改变是尘肺病常见的改变。然而，仅在2例矽肺患者中发现矽结节。7例患者的标本显示肉芽肿性炎症。肺泡壁受累程度与肺弥散功能值相关性良好，但与影像学改变相关性较差。X线阴影的密集程度与功能损害的相关性也较差。作为一种诊断工具，穿刺活检对石棉肺诊断价值较大，对混合粉尘纤维化诊断价值稍小。活检标本在75%的疑似石棉肺病例及86%最终诊断为石棉肺的病例中显示出与石棉肺相符的改变。在混合粉尘组中，分别有67%和80%的病例确诊为尘肺病。在矽肺诊断中，开放活检可能比经皮穿刺活检更可靠，尤其是在影像学改变轻微时。穿刺活检标本的组织学改变仅在36%的疑似矽肺病例及63%最终诊断为矽肺的病例中与矽肺相符。
