173例经支气管镜冷冻肺活检在弥漫性肺疾病中的病理诊断分析

Transbronchial lung cryobiopsy in diffuse lung disease:a pathological analysis of 173 cases

目的 探讨经支气管镜冷冻肺活检技术(TBCB)对肺部弥漫性疾病(DLD)病理诊断的价值.方法 收集广州医科大学附属第一医院2017年1月-2019年6月173例病因诊断不明需行TBCB检查的住院患者的临床病理资料,进行回顾性分析及总结,其中54例同时行TBCB和常规经支气管镜肺活检(TBLB),比较两者活检方法标本大小及病理诊断效率.结果 173例TBCB标本中,结合患者年龄、性别、职业、既往史、接触史、吸烟史、实验室血清学及影像学结果,最终病理组织学检查明确分型者有148例(85.5%),病理明确分型或有提示诊断者160例(92.5%),其中已知病因为72例(45.0%);特发性间质性肺炎27例(16.9%);7例肉芽肿性病变(4.4%);其他类型54例(33.8%).173例中54例同时行TBCB和TBLB,TBCB组和TBLB组标本的大小分别为(3.3±1.3)和(1.0±0.3) mm2(t'=12.67,P<0.01).TBCB组和TBLB组明确病理分型诊断效率分别为81.5%(44/54)和42.6%(23/54),差异有统计学意义(X2=17.33,P<0.01).其中TBCB组与TBLB组对间质性肺疾病明确分型的病理诊断效率分别为48.2% (26/54)和5.6%(3/54),差异有统计学意义(X2=24.94,P<0.01).而TBCB组与TBLB组诊断除间质性肺疾病以外的其他弥漫性肺疾病的病理诊断效率分别为33.33%(18/54)和37.04%(20/54),差异无统计学意义(x2=0.1624,P=0.687).结论 与TBLB相比较,TBCB所获得的标本大小及在确诊弥漫性肺疾病特别是间质性肺疾病分型上具有明显优势和应用价值.

Objective To evaluate the value of transbronchial lung cryobiopsy(TBCB)in pathological diagnosis for diffuse lung disease.Methods The clinicopathological data of 173 patients from the first affiliated hospital of Guangzhou medical university between Jaunary 2017 and June 2019 with transbronchial lung cryobiopsy of diffuse lung disease were retrospectively analyzed and summarized with review.Among 173 cases,TBCB and conventional transbronchial lung biopsy(TBLB)were performed in 54 patients.The size of biopsy samples and diagnostic yield were compared.Results Among 173 cases,the diagnostic yield was 85.54%(148/173),160(92.49%)cases provided definite diagnosis and valuable pathological results,according to age,sex,occupation,past history,contact history,smoking history,laboratory serology and imaging findings.Among 160 cases,there were 72 cases of known etiology(45.00%),27 cases of idiopathic interstitial pneumonia(16.88%),7 cases of granulomatous lesions(4.38%)and 54 cases of other types(33.75%).With TBCB and TBLB in 54 patients,the specimens sizes of TBCB and TBLB were(3.3±1.3)mm2 and(1.0±0.3)mm2 respectively(t′=12.67 P<0.01).The diagnostic yields of TBCB and TBLB were 81.48%(44/54)and 42.59%(23/54)respectively(χ2=17.33,P<0.01).The diagnostic yields of TBCB and TBLB for interstitial lung diseases were 48.15%(26/54)and 5.56%(3/54)respectively(χ2=24.94,P<0.01).However,the diagnostic yields of TBCB and TBLB for the other diffuse lung disease except interstitial lung diseases were 33.33%(18/54)and 37.04%(20/54)respectively,with no significant difference(χ2=0.1624,P=0.687).Conclusion Compared with TBLB,TBCB has obvious advantages and application value in the diagnosis of diffuse pulmonary diseases,especially interstitial pulmonary diseases.