European Respiratory Review最新文献

{"title":"Artificial intelligence-enabled histological analysis in pre-clinical respiratory disease models: a scoping review.","authors":"Eva Kuhar, Junsoo Park, Forough Jahandideh, Majid Komeili, Ahmed Sadeknury, Navneet Kang, Prarthna Karunamurthy, Mohammad Reza Zarei, Amir Ebrahimi, Sean E Gill, Patricia C Liaw, Dean A Fergusson, Duncan J Stewart, Arvind Mer, Manoj M Lalu","doi":"10.1183/16000617.0243-2025","DOIUrl":"10.1183/16000617.0243-2025","url":null,"abstract":"<p><p>Histological analysis is a cornerstone of pre-clinical respiratory disease research. It enables assessment of pathology, therapeutic effects, and mechanisms. However, conventional approaches rely on manual scoring, which is subjective, time-consuming, and difficult to scale. Artificial intelligence (AI), particularly deep learning, offers potential to automate histology workflows. To date, its use in pre-clinical respiratory models has not been synthesised.We conducted a scoping review following the Joanna Briggs Institute guidelines. We searched MEDLINE and Embase (inception - January 2025) for pre-clinical studies using AI to analyse histology in respiratory disease models. Screening, full-text review, and data extraction were performed in duplicate.Of 6271 studies screened, 29 met inclusion criteria. Most used murine models (76%) and investigated lung cancer (28%), pulmonary fibrosis (24%), or tuberculosis (17%). Haematoxylin and eosin was the most common stain (48%), with others targeting collagen or immune markers. AI tasks included image classification (n=20), segmentation (n=10), and object detection (n=4), predominantly using convolutional neural networks (69%). Pre-processing methods (<i>e.g.</i> stain normalisation) were common, but annotation and training practices were inconsistently reported. AI model performance was generally high (accuracy ≥90%; seven studies); however, validation metrics varied, and external validation was absent. Most studies used \"black box\" models, with minimal application of explainability techniques. Reproducibility measures, such as sharing datasets or code were rarely reported.AI tools are poised to transform histological analysis in pre-clinical respiratory research. The field will be able to further harness AI to automate pre-clinical respiratory histological analysis by addressing gaps that we have identified in validation, transparency, and standardisation.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution of scientific knowledge in childhood asthma over time.","authors":"Giuliana Ferrante, Laura Tenero, Marco Zaffanello, Michele Piazza, Giorgio Piacentini","doi":"10.1183/16000617.0256-2025","DOIUrl":"10.1183/16000617.0256-2025","url":null,"abstract":"<p><p>Paediatric asthma management has undergone a significant transformation from rudimentary assessments in the early 20th century to sophisticated diagnostic and therapeutic approaches today. Early clinical observations lacked paediatric specificity, but mid-20th-century studies introduced functional assessments, spirometry and recognition of asthma as a chronic inflammatory condition. The introduction of inhaled corticosteroids transformed long-term management, offering targeted control with reduced systemic risks. Advances in noninvasive diagnostics, such as fractional exhaled nitric oxide, induced sputum analysis, exhaled breath condensate and electronic nose technology, have improved inflammation monitoring, phenotype classification and therapeutic responsiveness. The integration of omics technologies, <i>i.e.</i> genomics, proteomics and metabolomics, has enabled deeper insights into disease mechanisms and facilitated early, individualised interventions. Concurrently, artificial intelligence (AI) and machine learning are emerging as tools for predicting exacerbations, identifying clinical subtypes and enhancing decision-making through large-scale data integration. Despite these advancements, challenges remain around standardisation, data quality and ensuring equitable access. This narrative review synthesises decades of progress in paediatric asthma care, emphasising the transition from empirical treatment to personalised, biomarker-driven strategies. It highlights current gaps, particularly in algorithm transparency, paediatric-specific validation and holistic care integration. As asthma management enters an era of digital health and AI-assisted precision medicine, future success will depend on interdisciplinary collaboration, real-world validation and policies that close care disparities.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonpharmacological dyspnoea-relief strategies in lung cancer: a systematic review and network meta-analysis.","authors":"Guoxiang Hu, Binu Koirala, Lufei Young, Cailing Liang, Wei Zhou, Qi Zhang","doi":"10.1183/16000617.0232-2025","DOIUrl":"10.1183/16000617.0232-2025","url":null,"abstract":"<p><strong>Background: </strong>Dyspnoea is a common and distressing symptom in lung cancer patients. While various dyspnoea-relief strategies show promise, their comparative effectiveness remains unclear.</p><p><strong>Methods: </strong>We conducted a systematic review and network meta-analysis of randomised controlled trials on nonpharmacological dyspnoea-relief strategies in lung cancer patients, using studies published until 12 June 2025 from the databases PubMed, Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The primary outcome was dyspnoea score post-intervention.</p><p><strong>Results: </strong>4138 participants from 46 randomised controlled trials were included in the analysis. Among 10 nonpharmacological dyspnoea-relief strategies in lung cancer patients, acupressure (surface under the cumulative ranking curve (SUCRA) 98.7%, Hedges' g -1.96, 95% CI -2.92 to -0.99) demonstrated the highest efficacy, followed by fan (SUCRA 83.7%, Hedges' g -1.11, 95% CI -1.72 to -0.50), and multicomponent interventions (SUCRA 80.7%, Hedges' g -1.01, 95% CI -1.49 to -0.52). In post-operative lung cancer patients, multicomponent interventions (SUCRA 97.4%, Hedges' g -1.55, 95% CI -2.16 to -0.94) were the most effective, followed by cognitive behavioural therapy (SUCRA 74.8%, Hedges' g -0.90, 95% CI -1.75 to -0.05). For patients with pre-existing dyspnoea, acupressure (SUCRA 90.9%, Hedges' g -1.72, 95% CI -3.01 to -0.42) and fan therapy (SUCRA 77.3%, Hedges' g -1.18, 95% CI -2.10 to -0.27) were the top interventions.</p><p><strong>Conclusions: </strong>Acupressure is the primary strategy for alleviating dyspnoea in lung cancer patients, including those with pre-existing dyspnoea, followed by fan therapy, while multicomponent interventions are recommended for post-operative patients.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidimensional determinants of BCG-induced false-positivity in tuberculin skin testing: a global meta-analysis of 242 studies.","authors":"Shunli Cai, Yuan Xia, Yingchen Zhou, Yangxuan Lin, Xin Guo, Yan Dong, Hongbo Chen, Jian He, Chao Song, Guozhong Zhou","doi":"10.1183/16000617.0204-2025","DOIUrl":"10.1183/16000617.0204-2025","url":null,"abstract":"<p><strong>Background: </strong>The tuberculin skin test (TST), widely used for latent tuberculosis infection (LTBI) screening, shows reduced specificity in Bacillus Calmette-Guérin (BCG)-vaccinated individuals due to antigenic cross-reactivity. We aimed to quantify the impact of BCG vaccination on false-positive TST results and to identify key modifying factors.</p><p><strong>Methods: </strong>We systematically searched Embase, PubMed, Web of Science and the Cochrane Library up to 24 February 2025. A dual-comparison design was applied: head-to-head comparisons of interferon-γ release assay (IGRA) <i>versus</i> TST in BCG-vaccinated populations and between-group comparisons of TST positivity in vaccinated <i>versus</i> unvaccinated groups. Random-effects models were used to calculate risk differences (RDs) for false-positive results.</p><p><strong>Results: </strong>A total of 242 studies were included, with 166 head-to-head (50 341 participants) and 176 between-group comparisons (456 429 participants). Both approaches yielded consistent estimates, including a head-to-head RD of 13% (95% CI 9-16%) and a between-group RD of 12% (95% CI 9-14%). False positivity decreased with increasing tuberculosis incidence and latitude. Immunosuppressed individuals showed lower RDs than general populations. BCG strain, age at vaccination and number of doses significantly influenced false positivity.</p><p><strong>Conclusions: </strong>We identified key modifiers of BCG-related TST false positivity. TST remains appropriate in high-incidence settings and for BCG specific strains, whereas IGRA may be preferred in low-incidence areas, in individuals vaccinated multiple times or in immunosuppressed individuals.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muscle sympathetic nerve activity in COPD: a systematic review and meta-analysis.","authors":"Brady Duiker, Safi Shirazi, Allison Sivak, Michael K Stickland, Margie H Davenport, Craig D Steinback","doi":"10.1183/16000617.0267-2025","DOIUrl":"10.1183/16000617.0267-2025","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease is a primary driver of mortality in COPD. Elevated sympathetic nerve activity is a key proposed mechanism, but the magnitude of this autonomic overactivity has not been quantified in a pooled analysis.</p><p><strong>Objective: </strong>To determine if adults with COPD exhibit higher resting muscle sympathetic nerve activity (MSNA) than healthy controls, assess associated cardiorespiratory effects, and evaluate the short-term impact of COPD interventions on MSNA.</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, eight databases were searched from inception to 15 May 2025 to inform this systematic review and meta-analysis (PROSPERO CRD420251044931). Eligible studies included adults with spirometry-defined COPD in whom MSNA was measured by microneurography at rest. Primary outcomes were MSNA burst frequency (bursts·min^-1) and incidence (bursts per 100 heartbeats). Secondary outcomes included resting heart rate and blood pressure.</p><p><strong>Results: </strong>A total of 11 studies (171 COPD participants, 105 controls) met inclusion criteria. Compared with controls, COPD was associated with markedly higher MSNA, burst frequency (+18.5, 95% CI 9.4-27.7 bursts·min^-1) and burst incidence (+21.3, 95% CI 9.2-33.4 bursts per 100 heartbeats). Resting heart rate was also elevated (+10.7, 95% CI 6.1-15.3 beats·min^-1), while blood pressure did not differ significantly. Three studies on noninvasive ventilation or inhaled β₂-agonists found no significant pooled changes in MSNA.</p><p><strong>Conclusions: </strong>Resting MSNA is significantly elevated in patients with COPD despite normal blood pressure. This chronic sympathetic excitation likely contributes to COPD-related cardiovascular morbidity and exercise intolerance, highlighting the importance of developing therapies that reduce sympathetic nerve activity.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of long-term noninvasive positive airway pressure therapy in patients with COPD: a systematic review and meta-analysis of acceptance and adherence.","authors":"Cheryl R Laratta, Linn Moore, Scott W Kirkland, Nana Owusu M Essel, Sandra M Campbell, Rachel Jen, Joanna E MacLean, Sachin R Pendharkar, Brian H Rowe","doi":"10.1183/16000617.0231-2025","DOIUrl":"10.1183/16000617.0231-2025","url":null,"abstract":"<p><strong>Background: </strong>Long-term noninvasive positive airway pressure (PAP) therapy is an effective, albeit complex, intervention for obstructive sleep apnoea (OSA) and/or chronic hypercapnic respiratory failure (CHRF) in patients with chronic obstructive pulmonary disease (COPD). PAP uptake and use is often reported in studies designed for other purposes. Systematic review methods were used to summarise acceptance of and adherence with PAP therapy.</p><p><strong>Methods: </strong>A systematic search for studies that reported the proportion of patients that either declined or accepted PAP therapy and/or objective use of newly prescribed PAP therapy in patients with COPD was conducted according to a predefined protocol (PROSPERO CRD42021259262). Meta-analysis and meta-regression techniques were used to establish summary effect estimates and explore heterogeneity.</p><p><strong>Results: </strong>On average, PAP therapy was declined or discontinued by 14% (95% CI 10-19) of participants, often within 6 weeks of initiation among studies reporting repeated measures. The pooled median adherence was 6.3 h·day^-1 (95% CI 5.9-6.6). While meta-regression found higher acceptance (p=0.03) and shorter use per day (p<0.01) for the indication of OSA <i>versus</i> CHRF, this explained only some heterogeneity in the summary effect estimates. Summary of study-level variables associated with acceptance or adherence highlighted limitations in the available literature.</p><p><strong>Conclusions: </strong>An anticipated six out of seven patients with COPD newly prescribed PAP therapy will be successful using therapy; however, heterogeneity was substantial among studies, and only partly explained by indication for use. Prospective studies to explore barriers to use and detailed reporting of acceptance and adherence in studies on PAP therapy in patients with COPD are needed.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validating exacerbations of asthma in electronic health records: a systematic review.","authors":"Elizabeth Moore, Zakariah Gassasse, Ian Sinha, Daniel B Hawcutt, Jennifer K Quint","doi":"10.1183/16000617.0004-2026","DOIUrl":"10.1183/16000617.0004-2026","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have shown that the algorithms and code lists used to define asthma exacerbations vary across different sources of data, if reported at all. Defining and validating asthma exacerbations in electronic health records (EHR) would help to improve future research on asthma using EHR by leading to more consistent and comparable evidence.</p><p><strong>Methods: </strong>We systematically reviewed the literature to evaluate studies that define exacerbations of asthma in EHR and report which algorithms have the highest validity. An adapted version of the QUADAS-2 designed for this review was used to assess risk of bias.</p><p><strong>Results: </strong>Of the studies yielded by the search, only five met the inclusion criteria. Eligible studies used algorithms that contained codes from versions or modifications of either the 9th or 10th revisions of the International Statistical Classification of Diseases and Related Health (ICD-9 or ICD-10), and validity scores varied. Using the ICD-9 code 493 within algorithms to detect asthma exacerbations, sensitivity scores varied from 44.8% to 91.28% and specificity was >85%. Using the ICD-9 code 493.xx as the principal and secondary diagnosis in claims data, validity measures were all >85%. Using the ICD-10 code J45, scores for sensitivity, specificity and negative predictive value were also all >85%.</p><p><strong>Conclusions: </strong>Algorithms have been used to identify asthma exacerbations in EHR with varying degrees of validity. Algorithms including the ICD-9 code 493.xx or the ICD-10 code J45 to detect asthma exacerbations had high validity scores. However, there was a risk of bias in these studies and urgent work is needed using robust methods to validate definitions for future research using EHR.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current understanding and future directions in severe asthma through artificial intelligence-integrated multi-omic approaches.","authors":"Sundhas Rafeeq Valappil, Mohammed Uddin, Saba Al Heialy","doi":"10.1183/16000617.0040-2025","DOIUrl":"10.1183/16000617.0040-2025","url":null,"abstract":"<p><p>Severe asthma remains a challenging, heterogeneous condition, despite significant advances in therapeutic strategies. A subset of patients continues to experience poor control, frequent exacerbations and a high burden of disease. The advent of multi-omic technologies, including genomics, transcriptomics, proteomics and metabolomics, has opened new avenues for understanding the molecular underpinnings of asthma. When combined with artificial intelligence (AI), these approaches hold the potential to transform and augment the management of severe asthma by identifying key biomarkers, refining disease endotypes and enabling personalised treatment strategies. This review explores the role of AI-integrated multi-omic approaches in asthma research, highlighting how AI-driven models can analyse vast datasets to uncover patterns often missed by traditional methods. These insights can improve diagnostic precision, predict therapeutic responses and guide the development of novel, targeted therapies. Key areas of focus include genetic loci associated with asthma severity, single-cell RNA sequencing to uncover cellular heterogeneity, and proteomic profiles that differentiate asthma phenotypes. Through this review, we aim to provide readers with a clear understanding of the current landscape in severe asthma research, highlighting the breakthroughs achieved through AI-integrated multi-omic approaches. Additionally, we aspire to guide the future direction of the field by addressing the challenges that remain in translating these discoveries into clinical practice. By fostering a deeper understanding of the potential of these technologies, we hope to inspire further innovations that will pave the way for precision medicine to transform severe asthma management, ultimately leading to more personalised and effective treatment options for patients.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition and growth of primary ciliary dyskinesia patients: a systematic review.","authors":"Nena Karavasiloglou, Vasiliki Gkatzou, Andrea Fernandez-Rodriguez, Valérie Schwartz, Myrofora Goutaki","doi":"10.1183/16000617.0024-2026","DOIUrl":"10.1183/16000617.0024-2026","url":null,"abstract":"<p><strong>Background: </strong>Growth, nutritional status and intake can be crucial for the management and prognosis of chronic lung diseases, including primary ciliary dyskinesia (PCD); yet research in PCD is scarce. In this study, we systematically reviewed the existing literature and summarised the evidence on growth, nutritional status and intake of patients with PCD.</p><p><strong>Methods: </strong>We conducted searches in Medline, Embase, Scopus and PubMed limited to the past 20 years, due to changes in the diagnosis of PCD. Eligible studies included cross-sectional, case-control and prospective studies, and case series with >5 people that reported on the growth, nutritional status or intake of patients with PCD. We performed additional searches through reference list checking and in medRxiv for relevant preprints. The review was registered in PROSPERO (CRD420251065699).</p><p><strong>Results: </strong>50 studies were included in the qualitative synthesis. We observed variability in growth-related outcomes, with some studies reporting reduced z-score for height, body weight or BMI, while others reported no growth differences in patients with PCD. The prevalence of undernutrition ranged from 4 to 11%; underweight ranged from 0 to 50%. Overweight and obesity estimates ranged from 3 to 25%. The prevalence of vitamin D insufficiency was 54%, while deficiency was reported in 18-26% of study participants. Only three studies reported on the nutritional intake of patients with PCD.</p><p><strong>Discussion: </strong>We observed considerable variability in growth-related outcomes and a lack of nutritional intake-related data in patients with PCD. The findings we noted related to malnutrition and vitamin D insufficiency/deficiency are alarming and warrant further investigation.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Yield and safety of different biopsy types in interstitial lung disease: a systematic review and meta-analysis.","authors":"Elad Mor, Luca Alessandro Belmonte, Mauro Degrassi, Daniel-Costin Marinescu, Christopher J Ryerson","doi":"10.1183/16000617.0044-2026","DOIUrl":"10.1183/16000617.0044-2026","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}