背景:以前没有评估高清晰度(HD)视频支气管镜检查检测结节病气道受累的能力。
目的:高清视频支气管镜检查在鉴别结节病相关气道异常(AA)中的作用是什么?在支气管内活检(EBB)中更常见和更常见的与肉芽肿检测相关的AA模式是什么?方法
:在本前瞻性中,国际,多中心队列研究,连续怀疑结节病的患者接受了使用HD视频支气管镜和EBB的气道检查,采用标准化工作流程.AA根据六种定义的“先验”模式进行分类:结节,用鹅卵石敲打,增厚,牌匾,血管增加,和杂项。我们评估了EBB的诊断产量,AA的患病率,EBB的诊断产量和观察者对不同AA模式的一致性。
结果:在64/134(47.8%)结节病患者中发现了AA,具有结节性(23,17.2%),斑块(19,14.2%)和血管分布增加(19,14.2%)是最普遍的。EBB的诊断率为36.6%。在EBB中,AA的患病率明显高于无坏死性肉芽肿的患者(67.4%VS36.5%,P=0.001)。同样,与EBB中没有非坏死性肉芽肿的患者相比,CT上的实质性疾病明显更常见(79.6%VS54.1%,P=0.003)。在每个病变分析中,非坏死性肉芽肿尤其见于EBB,取自鹅卵石区(9/10,90%)和结节区(17/29,58.6%)。随机EBB的总诊断率较低(31/134,23.1%)。对于AA的不同模式,观察者之间的协议是公平的(Fleissk=0.34)。
结论:在欧洲白人患病率较高的人群中,HD视频支气管镜检查在大约一半的结节病患者中检测到AA。在CT上有实质受累的患者和有气道异常的患者中,EBB的诊断率较高。特别是如果表现为鹅卵石和结节。
背景:Clinicaltrials.gov,标识符NCT4743596。
The ability of high-definition (HD) videobronchoscopy to detect airway involvement in sarcoidosis has not been evaluated previously.
What is the role of HD videobronchoscopy in the identification of sarcoidosis-associated airway abnormalities (AAs)? What are the patterns of AAs more commonly observed and more frequently associated with the detection of granulomas in endobronchial biopsy (EBB)?
In this prospective international multicenter cohort
study, consecutive patients with suspected sarcoidosis underwent airway inspection with an HD videobronchoscope and EBB using a standardized workflow. AAs were classified according to six patterns defined a priori: nodularity, cobblestoning, thickening, plaque, increased vascularity, and miscellaneous. We assessed diagnostic yield of EBB, prevalence of AAs, and interobserver agreement for different patterns of AAs.
AAs were identified in 64 of 134 patients with sarcoidosis (47.8%), with nodularity (n = 23 [17.2%]), plaque (n = 19 [14.2%]), and increased vascularity (n = 19 [14.2%]) being the most prevalent. The diagnostic yield of EBB was 36.6%. AAs were significantly more prevalent in patients with than in those without nonnecrotizing granulomas on EBB (67.4% vs 36.5%; P = .001). Likewise, parenchymal disease on CT scan imaging was significantly more common in patients with than in those without nonnecrotizing granulomas on EBB (79.6% vs 54.1%; P = .003). On a per-lesion analysis, nonnecrotizing granulomas were seen especially in EBB samples obtained from areas of cobblestoning (9/10 [90%]) and nodularity (17/29 [58.6%]). The overall diagnostic yield of random EBB was low (31/134 [23.1%]). The interobserver agreement for the different patterns of AA was fair (Fleiss κ = 0.34).
In a population with a large prevalence of White Europeans, HD videobronchoscopy detected AAs in approximately one-half of patients with sarcoidosis. The diagnostic yield of EBB was higher in patients with parenchymal involvement on CT scan imaging and in those with AAs, especially if manifesting as cobblestoning and nodularity.
ClinicalTrials.gov; No.: NCT4743596; URL: www.
gov.