Yield and safety of different biopsy types in interstitial lung disease: a systematic review and meta-analysis.

IF 10.8 1区医学 Q1 RESPIRATORY SYSTEM

European Respiratory Review Pub Date : 2026-05-13 Print Date: 2026-04-01 DOI:10.1183/16000617.0044-2026

Elad Mor, Luca Alessandro Belmonte, Mauro Degrassi, Daniel-Costin Marinescu, Christopher J Ryerson

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引用次数: 0

Abstract

Background: Lung biopsy remains an important consideration in the management of interstitial lung disease (ILD). Transbronchial lung cryobiopsy (TBLC) offers an alternative to traditional surgical lung biopsy (SLB) and transbronchial forceps biopsy (TBB); however, up-to-date comparisons between these methods in ILD, particularly fibrotic ILD, remain limited.

Methods: A comprehensive literature search of Medline, Embase and Evidence-Based Medicine Reviews was performed for studies published between January 2000 and September 2025 to identify all citations reporting yield and complications of the three main lung biopsy methods for ILD.

Results: A total of 143 studies were included. Pooled multidisciplinary yield (following multidisciplinary discussion) in TBB, TBLC and SLB was 35.3% (95% CI 21.3-52.5), 84.3% (95% CI 81.7-86.5) and 88.6% (95% CI 83.4-92.3), respectively. For fibrotic ILD, the multidisciplinary yield was 12.5% (only one eligible study), 87.6% (95% CI 83.5-90.7) and 87.3% (95%CI 80.5-92.0), respectively. Meta-regression showed an increasing multidisciplinary yield of TBLC with more recent years of patient recruitment and an increasing percentage of fibrotic ILD in each study. The multidisciplinary yield of both TBLC and SLB was 85-90%, suggesting a biopsy "ceiling effect". All evaluated complications were more frequent in TBLC compared to TBB and some were more frequent in SLB compared to TBLC. Several complications were more frequent in fibrotic ILD compared to all ILD.

Conclusions: The multidisciplinary yield of TBLC and SLB is equivalent, with both offering an acceptable safety profile. TBB has low yield, particularly in fibrotic ILD. These findings support using either TBLC or SLB as an initial diagnostic tool in fibrotic ILD, mainly based on patient-physician shared decision-making.

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不同活检类型在间质性肺疾病中的疗效和安全性：一项系统综述和荟萃分析。

背景：肺活检仍然是间质性肺疾病（ILD）治疗的重要考虑因素。经支气管肺低温活检（TBLC）提供了传统手术肺活检（SLB）和经支气管钳活检（TBB）的替代方案；然而，这些方法在ILD，特别是纤维化ILD中的最新比较仍然有限。方法：对2000年1月至2025年9月间发表的研究进行Medline、Embase和循证医学评论的综合文献检索，以确定报告ILD的三种主要肺活检方法的产量和并发症的所有引用。结果：共纳入143项研究。TBB、TBLC和SLB的合并多学科成功率（经过多学科讨论）分别为35.3% （95% CI 21.3-52.5）、84.3% （95% CI 81.7-86.5）和88.6% （95% CI 83.4-92.3）。对于纤维化性ILD，多学科发生率分别为12.5%（仅有一项符合条件的研究）、87.6% （95%CI 83.5-90.7）和87.3% （95%CI 80.5-92.0）。meta回归显示，随着近年来患者招募的增加，TBLC的多学科产量也在增加，每项研究中纤维化性ILD的比例也在增加。TBLC和SLB的多学科检出率均为85-90%，提示活检存在“天花板效应”。所有评估的并发症在TBLC中比TBB更常见，在SLB中比TBLC更常见。与所有ILD相比，纤维化ILD的一些并发症更为常见。结论：TBLC和SLB的多学科疗效相当，均具有可接受的安全性。TBB的发生率很低，尤其是在纤维化的ILD中。这些发现支持使用TBLC或SLB作为纤维化ILD的初始诊断工具，主要基于患者和医生的共同决策。

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

European Respiratory Review Medicine-Pulmonary and Respiratory Medicine

CiteScore

14.40

自引率

1.30%

发文量

审稿时长

24 weeks

期刊介绍： The European Respiratory Review (ERR) is an open-access journal published by the European Respiratory Society (ERS), serving as a vital resource for respiratory professionals by delivering updates on medicine, science, and surgery in the field. ERR features state-of-the-art review articles, editorials, correspondence, and summaries of recent research findings and studies covering a wide range of topics including COPD, asthma, pulmonary hypertension, interstitial lung disease, lung cancer, tuberculosis, and pulmonary infections. Articles are published continuously and compiled into quarterly issues within a single annual volume.