Rao V K, Ritter J, Kollef M H
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
Chest. 1998 Aug;114(2):549-55. doi: 10.1378/chest.114.2.549.
To determine the diagnostic yield of histologic specimens obtained by postmortem transbronchial biopsy (TBB) in patients with acute respiratory failure requiring mechanical ventilation.
Standard postmortem histologic examination of lung tissue specimens.
An urban university-affiliated hospital.
Thirty patients with diffuse pulmonary infiltrates and acute respiratory failure, who underwent postmortem examination.
Following removal of the lungs from the thorax. TBBs were obtained from the lower lobe of each deflated lung and comparison was made to a 1-cm3 tissue block obtained from the ipsilateral lower lobe.
Standard postmortem histologic examination provided a specific diagnosis in 85% of the 60 lungs examined, and histologic evidence of acute pneumonia was present in 30% of the lungs. The overall yield of TBB was 48% for establishing a specific histologic diagnosis and 15% for the diagnosis of acute pneumonia. Using standard postmortem histologic examination as the gold standard, the sensitivity and specificity of TBB for making a specific diagnosis were 57% and 100% respectively, with corresponding positive and negative predictive values of 100% and 29%. For the histologic diagnosis of acute pneumonia, the sensitivity of TBB was 50%, the specificity was 100%, and the positive and negative predictive values were 100% and 82%, respectively. The kappa statistic for the agreement between the two diagnostic methods was 0.28 for establishing a specific diagnosis and 0.58 for the diagnosis of acute pneumonia. Obtaining 12 TBBs rather than six TBBs did not increase the diagnostic yield for TBB.
These findings suggest poor overall agreement between standard postmortem histologic examination and TBB specimens. Although not performed in a clinical setting, this postmortem investigation suggests that TBB may be of limited value in mechanically ventilated patients with acute respiratory failure because of its low sensitivity.
确定在需要机械通气的急性呼吸衰竭患者中，经支气管镜肺活检（TBB）获取的组织学标本的诊断价值。
对肺组织标本进行标准的尸检组织学检查。
一家城市大学附属医院。
30例患有弥漫性肺浸润和急性呼吸衰竭且接受了尸检的患者。
从胸腔取出肺脏后，从每个萎陷肺的下叶获取TBB标本，并与从同侧下叶获取的1立方厘米组织块进行比较。
标准尸检组织学检查在60个被检查的肺中，85%给出了明确诊断，30%的肺存在急性肺炎的组织学证据。TBB确立明确组织学诊断的总体阳性率为48%，诊断急性肺炎的阳性率为15%。以标准尸检组织学检查作为金标准，TBB做出明确诊断的敏感性和特异性分别为57%和100%，相应的阳性预测值和阴性预测值分别为100%和29%。对于急性肺炎的组织学诊断，TBB的敏感性为50%，特异性为100%，阳性预测值和阴性预测值分别为100%和82%。两种诊断方法之间一致性的kappa统计量，对于确立明确诊断为0.28，对于诊断急性肺炎为0.58。获取12个TBB标本而非6个TBB标本并未提高TBB的诊断阳性率。
这些发现表明标准尸检组织学检查与TBB标本之间总体一致性较差。尽管并非在临床环境中进行，但这项尸检研究表明，由于其低敏感性，TBB在机械通气的急性呼吸衰竭患者中可能价值有限。
