Abstract：
Transbronchial cryobiopsy (TBCB) is increasingly used for the diagnosis of fibrosing interstitial pneumonias, but there are few detailed descriptions of the pathologic findings in such cases. It has been proposed that a combination of patchy fibrosis and fibroblast foci with an absence of alternative features is diagnostic of usual interstitial pneumonia (UIP; ie, idiopathic pulmonary fibrosis [IPF]) in TBCB. In this study, we reviewed 121 TBCB in which a diagnosis of fibrotic hypersensitivity pneumonitis (FHP; n = 83) or IPF (n = 38) was made by multidisciplinary discussion and evaluated a range of pathologic features. Patchy fibrosis was found in 65 of 83 (78%) biopsies from FHP and 32of 38 (84%) biopsies from UIP/IPF cases. Fibroblast foci were present in 47 of 83 (57%) FHP and 27 of 38 (71%) UIP/IPF cases. Fibroblast foci/patchy fibrosis combined did not favor either diagnosis. Architectural distortion was seen in 54 of 83 (65%) FHP and 32 of 38 (84%) UIP/IPF cases (odds ratio [OR] for FHP, 0.35; P = .036) and honeycombing in 18 of 83 (22%) and 17 of 38 (45%), respectively (OR, 0.37; P = .014). Airspace giant cells/granulomas were present in 13 of 83 (20%) FHP and 1 of 38 (2.6%) UIP/IPF cases (OR for FHP, 6.87; P = .068), and interstitial giant cells/granulomas in 20 of 83 (24%) FHP and 0 of 38 (0%) UIP/IPF (OR, 6.7 x 106; P = .000). We conclude that patchy fibrosis plus fibroblast foci can be found in TBCB from both FHP and UIP/IPF. The complete absence of architectural distortion/honeycombing favors a diagnosis of FHP, as does the presence of airspace or interstitial giant cells/granulomas, but these measures are insensitive, and many cases of FHP cannot be separated from UIP/IPF on TBCB.
摘要：
经支气管冷冻活检（TBCB）越来越多地用于纤维化间质性肺炎的诊断，但是在这种情况下，很少有关于病理结果的详细描述。有人提出，斑片状纤维化和成纤维细胞灶的组合没有替代特征，可以诊断出常见的间质性肺炎（UIP；即特发性肺纤维化,IPF)在TBCB中。在这里，我们回顾了121TBCB，其中诊断为纤维化过敏性肺炎（FHP，通过多学科讨论进行N=83）或IPF（N=38），并评估了一系列病理特征。在FHP的65/83（78％）活检和UIP/IPF病例的32/38（84％）活检中发现了斑片状纤维化。在47/83（57％）FHP和27/38（71％）UIP/IPF病例中存在成纤维细胞灶。成纤维细胞灶/斑片状纤维化合并均不利于诊断。在54/83（65％）FHP和32/38（84％）UIP/IPF病例（FHP0.35的比值比（OR），p=0.036）和18/83（22％）的蜂窝状中发现了建筑变形/38（45％）（OR0.37，p=0.014）。13/83例(20%)FHP和1/38例(2.6%)UIP/IPF病例中存在空气空间巨细胞/肉芽肿(OR为FHP6.87,p=0.068),20/83（24％）FHP和0/38（0％）UIP/IPF中的间质巨细胞/肉芽肿（OR6.7x106，p=0.000）。我们得出的结论是，在FHP和UIP/IPF的TBCB中都可以发现斑片状纤维化加成纤维细胞灶。完全没有建筑扭曲/蜂窝有利于诊断FHP，如存在空域或间质巨细胞/肉芽肿，但是这些措施不敏感，许多FHP病例无法与TBCB上的UIP/IPF分离。
