不同肺活检方法对弥漫性肺间质性疾病的诊断价值

The diagnosis of diffuse interstitial lung diseases by different lung biopsy approaches

目的 探讨不同肺活检方法 ,特别是外科肺活检在肺间质性疾病诊断中的价值。方法 回顾性分析因弥漫性肺间质性疾病接受经支气管镜肺活检 (TBLB)、CT引导下经皮肺活检 (经皮肺活检 )及电视胸腔镜 (VATS)或小开胸肺活检患者的临床和病理诊断资料。结果 7例患者接受TBLB ,6例病理诊断为肺间质纤维化。 8例患者接受经皮肺活检 ,6例诊断特发性间质性肺炎(IIP) ,其中 4例得到病理分型 ,1例诊断结核。VATS或小开胸肺活检 15例 ,病理诊断IIP 11例 ,其中非特异性间质性肺炎 (NSIP) 7例 ,普通型间质性肺炎 (UIP) 3例 ,弥漫性肺泡损伤 (DAD) 1例 ,全部得到病理分类 ;发现腺癌 1例 ,结核 1例 ,非特异性病变 2例。结论 在诊断弥漫性肺间质性疾病时 ,可首先考虑创伤性小的TBLB和经皮肺活检 ,以除外感染和肿瘤。IIP的病理诊断特别是病理分型需要较大的活检组织 。

Objective To evaluate the diagnostic significances of pathological studies from lung samples obtained by different lung biopsy modalities in diffuse interstitial lung diseases (ILDs) .Methods Clinical and pathological data were retrospectively analyzed from patients with diffuse ILDs of unknown etiology.Transbronchial lung biopsy (TBLB),CT-guided percutaneous lung biopsy (PCLB),lung biopsy by video-assisted thoracoscopic surgery (VATS) or open lung biopsy had been performed to obtain lung tissues for a pathologic diagnosis.Results TBLB was performed in 7 patients in which 6 cases were diagnosed as interstitial pulmonary fibrosis.PCLB was performed in 8 patients in which the pathologic study confirmed tuberculosis in 1 case,idiopathic interstitial pneumonia (IIP) in 6 cases with pathologic patterns recognized in 4.Among 15 cases underwent surgical lung biopsy,11 were found to have IIP including 7 cases of nonspecific interstitial pneumonia (NSIP),3 cases of usual interstitial pneumonia (UIP), and 1 case of diffuse alveolar damage (DAD).Tuberculosis and adenocarcinoma were found in two patients respectively while pathology was nonspecific in the remaining 2 cases.Conclusions TBLB and/or PCLB should be considered to be the first choices to exclude infectious and malignant diseases masquerading as ILDs.Surgical lung biopsy is often necessary to make a definitive diagnosis and a histologic classification of IIPs.