Transbronchial Lung Cryobiopsy Performed with Cone Beam Computed Tomography Guidance Versus Fluoroscopy: A Retrospective Cohort Review.

IF 4.6 2区 医学 Q1 RESPIRATORY SYSTEM
Lung Pub Date : 2024-02-01 Epub Date: 2023-12-21 DOI:10.1007/s00408-023-00663-1
Syed O Ali, Carson Castellani, Bryan S Benn
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引用次数: 0

Abstract

Purpose: Determining the cause of interstitial lung disease (ILD) remains challenging. While surgical lung biopsy remains the gold standard approach, risks associated with it may be prohibitive. Transbronchial lung cryobiopsy (TBLC) is a minimally invasive alternative with an improved safety profile and acceptable diagnostic accuracy. We retrospectively assessed whether the use of Cone Beam computed tomography guidance for TBLC (TBLC-CBCT) improves safety and diagnostic yield compared to performing TBLC with fluoroscopic guidance (TBLC-F).

Methods: A retrospective cohort review of 120 patients presenting for evaluation of newly diagnosed ILD was performed. Demographic data, pulmonary function test values, chest imaging pattern, procedural information, and final multidisciplinary discussion (MDD) diagnosis were recorded.

Results: 62 patients underwent TBLC-F and 58 underwent TBLC-CBCT. Patients undergoing TBLC-CBCT were older (67.86 ± 10.97 vs 61.45 ± 12.77 years, p = 0.004) and had a higher forced vital capacity percent predicted (73.80 ± 17.32% vs 66.00 ± 17.45%, p = 0.03) compared to the TBLC-F group. The average probe-to-pleura distance was 5.1 ± 2.3 mm in the TBLC-CBCT group with 4.0 ± 0.3 CBCT spins performed. Pneumothorax occurred more often in the TBLC-F group (n = 6, 9.7%) compared to the TBLC-CBCT group (n = 1, 1.7%, p = 0.06). Grade 2 bleeding only occurred in the TBLC-F group (n = 4, 6.5%). A final MDD diagnosis was obtained in 89% (n = 57) of TBLC-F patients and 95% (n = 57) of TBLC-CBCT patients.

Conclusions: TBLC-CBCT appears to be safer compared to TBLC-F with both approaches facilitating an MDD diagnosis. Further studies from multiple institutions randomizing patients to each modality are needed to confirm these findings.

在锥形束计算机断层扫描引导下进行经支气管肺冷冻活组织检查与透视检查的对比:回顾性队列研究。
目的:确定间质性肺病(ILD)的病因仍然具有挑战性。虽然手术肺活检仍是金标准方法,但其风险可能令人望而却步。经支气管肺冷冻活检(TBLC)是一种微创替代方法,具有更好的安全性和可接受的诊断准确性。我们回顾性地评估了在锥形束计算机断层扫描引导下进行 TBLC(TBLC-CBCT)与透视引导下进行 TBLC(TBLC-F)相比,是否能提高安全性和诊断率:方法: 对 120 名前来评估新诊断 ILD 的患者进行了回顾性队列研究。记录了人口统计学数据、肺功能测试值、胸部成像模式、手术信息和多学科讨论(MDD)的最终诊断结果:62名患者接受了TBLC-F检查,58名患者接受了TBLC-CBCT检查。与 TBLC-F 组相比,接受 TBLC-CBCT 的患者年龄更大(67.86 ± 10.97 岁 vs 61.45 ± 12.77 岁,p = 0.004),预测用力肺活量百分比更高(73.80 ± 17.32% vs 66.00 ± 17.45%,p = 0.03)。TBLC-CBCT 组探头到胸膜的平均距离为 5.1 ± 2.3 毫米,CBCT 旋转次数为 4.0 ± 0.3 次。与 TBLC-CBCT 组(n = 1,1.7%,p = 0.06)相比,TBLC-F 组(n = 6,9.7%)发生气胸的频率更高。二级出血仅发生在 TBLC-F 组(n = 4,6.5%)。89%的TBLC-F患者(n = 57)和95%的TBLC-CBCT患者(n = 57)最终确诊为MDD:结论:与 TBLC-F 相比,TBLC-CBCT 似乎更安全,两种方法都有助于 MDD 诊断。要证实这些研究结果,还需要多个机构对每种方法的患者进行随机分组,开展进一步的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Lung
Lung 医学-呼吸系统
CiteScore
9.10
自引率
10.00%
发文量
95
审稿时长
6-12 weeks
期刊介绍: Lung publishes original articles, reviews and editorials on all aspects of the healthy and diseased lungs, of the airways, and of breathing. Epidemiological, clinical, pathophysiological, biochemical, and pharmacological studies fall within the scope of the journal. Case reports, short communications and technical notes can be accepted if they are of particular interest.
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