理由:2018年,进行了一项系统评价,评估间质性肺病(ILD)患者的经支气管肺冷冻活检(TBLC),以告知美国胸科学会,欧洲呼吸学会,日本呼吸学会,以及关于特发性肺纤维化诊断的LatinoamericanadelTórax临床实践指南。目标:进行新的系统评价以告知更新的指南。方法:Medline,摘录医学数据库,并在2020年6月之前搜索了Cochrane中央对照试验登记册(CCTR)。选择纳入ILD患者并报告TBLC诊断率或并发症发生率的研究。提取数据,然后通过荟萃分析汇总研究。证据的质量是通过建议的评分来评估的,评估,发展,和评价方法。结果:TBLC的组织病理学诊断率(产生组织病理学诊断的手术次数除以手术总数)为80%(95%置信区间[CI],76-83%)在ILD患者中。在30%(95%CI,20-41%)和8%(95%CI,6-11%)的患者中,TBLC并发出血和气胸,分别。手术相关死亡率,严重出血,长时间的漏气,急性加重,呼吸衰竭,呼吸道感染很少见。由于不受控制的研究设计,证据的质量非常低,缺乏连续入学,和不一致的结果。结论:极低质量的证据表明,TBLC在ILD患者中的诊断率约为80%。可控制的并发症。
Rationale: In 2018, a systematic
review evaluating transbronchial lung cryobiopsy (TBLC) in patients with interstitial lung disease (ILD) was performed to inform American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax clinical practice guidelines on the diagnosis of idiopathic pulmonary fibrosis. Objectives: To perform a new systematic
review to inform updated guidelines. Methods: Medline, Excerpta Medica Database, and the Cochrane Central Register of Controlled Trials (CCTR) were searched through June 2020. Studies that enrolled patients with ILD and reported the diagnostic yield or complication rates of TBLC were selected for inclusion. Data was extracted and then pooled across studies via meta-analysis. The quality of the evidence was appraised using the grading of recommendations, assessment, development, and evaluation approach. Results: Histopathologic diagnostic yield (number of procedures that yielded a histopathologic diagnosis divided by the total number of procedures performed) of TBLC was 80% (95% confidence interval [CI], 76-83%) in patients with ILD. TBLC was complicated by bleeding and pneumothorax in 30% (95% CI, 20-41%) and 8% (95% CI, 6-11%) of patients, respectively. Procedure-related mortality, severe bleeding, prolonged air leak, acute exacerbation, respiratory failure, and respiratory infection were rare. The quality of the evidence was very low owing to the uncontrolled study designs, lack of consecutive enrollment, and inconsistent results. Conclusions: Very low-quality evidence indicated that TBLC has a diagnostic yield of approximately 80% in patients with ILD, with manageable complications.