一个系统的审查的程序和采样技术的冷活检在间歇性肺部疾病
Julia A Lachowicz1,2, Natasha E Smallwood3,4, Jyotika D Prasad5,4,6,7
1Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia julia.lachowicz@mh.org.au.
概括
跨支气管肺冷活检 (TBLC) 为间歇性肺病 (ILD) 提供了81%的诊断收益率. 诸如全身麻醉和探针尺寸之类的程序性因素显著影响TBLC.
科学领域:
- 肺部病理学 肺部病理学
- 干预性肺病学 干预性肺病学
- 诊断程序 诊断程序 诊断程序
背景情况:
- 跨支气管肺冷活检 (TBLC) 作为手术肺活检的替代方案,用于诊断间歇性肺病 (ILD),可靠性较低.
- 目前关于TBLC诊断性能和安全性的文献,特别是关于程序和采样技术的文献,需要综合.
- 无法分类的ILD需要可靠的组织病理学评估方法.
研究的目的:
- 综合有关TBLC诊断性能和安全性的当前文献.
- 专注于程序和采样技术对TBLC结果的影响.
- 确定影响结核癌诊断产量和并发症率的因素.
主要方法:
- 对2022年4月11日之前发表的研究进行了系统的元分析.
- 包括专注于无法分类的ILD成年人的研究,报告诊断产量,并发症和TBLC技术.
- 对诊断产量,肺胸部和出血进行了元分析,分组分析评估了方法变量.
主要成果:
- 结核癌的整体诊断产量为81% (95%CI79-83%),与全身麻醉,多学科ILD会议,2.4毫米冷探针和更高的肺功能参数相关的产量有所改善.
- 肺胸发生在5% (95% CI 4-5%) 的病例中,病例增加率与2.4毫米冷探针,例行术后成像和多叶抽样有关.
- 中度至重度出血发生在12% (11-14%) 的病例中,与2.4毫米冷探针和特定出血评分选择相关的更高率.
结论:
- 患者的特征和可修改的因素,包括程序和麻醉技术,显著影响TBLC的诊断产量和安全性在不可分类的ILD.
- 这些变量有助于TBLC观察到的临床结果的异质性.
- 个性化临床决策和未来指导方针的制定应该考虑这些因素,在研究中需要进行例行报告.
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