Julia A Lachowicz, Natasha E Smallwood, Jyotika D Prasad, Purab Patel, Catherine Voutier, Yet H Khor, Daniel P Steinfort
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PROSPERO registration: CRD42022312386.</p><p><strong>Results: </strong>70 studies were included with 6183 participants. Diagnostic yield of TBLC was 81% (95% CI 79-83%, I<sup>2</sup>=97%), with better yield being observed with general anaesthesia (p=0.007), ILD multidisciplinary meeting prior to cryobiopsy (p=0.02), 2.4 mm cryoprobe (p=0.04), higher mean forced vital capacity (p=0.046) and higher mean diffusing capacity for carbon monoxide (p=0.023). Pneumothorax rate was 5% (95% CI 4-5%, I<sup>2</sup>=91%), with higher rates associated with a 2.4 mm cryoprobe (p<0.00001), routine post-procedure imaging (p<0.00001), multiple lobe sampling (p<0.0001), reduced mean diffusing capacity for carbon monoxide (p=0.028) and general anaesthesia (p=0.05). 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引用次数: 0
摘要
背景：经支气管肺冷冻活检（TBLC）是手术肺活检的替代方法，用于对无法分类的间质性肺病（ILD）或低置信度诊断的间质性肺病进行组织病理学评估。这项荟萃分析综合了目前有关冷冻活检诊断性能和安全性的文献，重点关注程序和取样技术：方法：检索了2022年4月11日的Medline和Embase。研究纳入了患有不可分类 ILD 的成人，报告了 TBLC 的诊断率、并发症和方法技术。对诊断率、气胸和出血进行了元分析。分组分析和元回归评估了方法学变量。PROSPERO 注册：CRD42022312386.Results:结果：共纳入 70 项研究，6183 名参与者。TBLC的诊断率为81%（95% CI 79-83%，I2=97%），全身麻醉（p=0.007）、冷冻活组织切片检查前的ILD多学科会议（p=0.02）、2.4毫米冷冻探针（p=0.04）、更高的平均强迫生命容量（p=0.046）和更高的平均一氧化碳弥散容量（p=0.023）可观察到更高的诊断率。气胸发生率为5%（95% CI 4-5%，I2=91%），2.4毫米低温探头的发生率更高（p2=95%），2.4毫米低温探头的发生率更高（p=0.001），出血评分选择也与之相关（p=0.04）：患者特征和可改变因素（包括手术方法和麻醉技术）影响了不可分类ILD患者TBLC的诊断率和安全结果，并导致了临床结果的异质性。在制定个体化临床决策和指南时应考虑这些变量，并在今后的研究中进行常规报告。
A systematic review of procedural and sampling techniques for cryobiopsy in interstitial lung disease.
Background: Transbronchial lung cryobiopsy (TBLC) is an alternative to surgical lung biopsy for histopathological evaluation of unclassifiable interstitial lung disease (ILD) or ILD diagnosed with low confidence. This meta-analysis synthesised current literature regarding cryobiopsy diagnostic performance and safety, focusing on procedural and sampling techniques.
Methods: Medline and Embase were searched on 11 April 2022. Studies included adults with unclassifiable ILD, reporting diagnostic yield, complications and methodological techniques of TBLC. Meta-analyses were performed for diagnostic yield, pneumothorax and bleeding. Subgroup analyses and meta-regression assessed methodological variables. PROSPERO registration: CRD42022312386.
Results: 70 studies were included with 6183 participants. Diagnostic yield of TBLC was 81% (95% CI 79-83%, I2=97%), with better yield being observed with general anaesthesia (p=0.007), ILD multidisciplinary meeting prior to cryobiopsy (p=0.02), 2.4 mm cryoprobe (p=0.04), higher mean forced vital capacity (p=0.046) and higher mean diffusing capacity for carbon monoxide (p=0.023). Pneumothorax rate was 5% (95% CI 4-5%, I2=91%), with higher rates associated with a 2.4 mm cryoprobe (p<0.00001), routine post-procedure imaging (p<0.00001), multiple lobe sampling (p<0.0001), reduced mean diffusing capacity for carbon monoxide (p=0.028) and general anaesthesia (p=0.05). Moderate-to-severe bleeding rate was 12% (11-14%, I2=95%) and higher rates were associated with a 2.4 mm cryoprobe (p=0.001) and bleeding score selection (p=0.04).
Interpretation: Patient characteristics and modifiable factors, including procedural methods and anaesthetic techniques, impacted diagnostic yield and safety outcomes of TBLC in people with unclassifiable ILD and contributed to heterogeneity of clinical outcomes. These variables should be considered for individualised clinical decision making and guideline development and warrant routine reporting in future research.
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.
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