Lung biopsy in the diagnosis and management of chILD.
Lung biopsy in the diagnosis and management of chILD.
复制标题
肺活检在儿童诊断和治疗中的应用。
DOI：
10.1002/ppul.26454
复制
发表时间：
2023
影响因子：
3.1
通讯作者：
Young,LisaR
中科院分区：
文献类型：
--
作者：
Deutsch,GailH;Young,LisaR
儿童间质性和弥漫性肺疾病 (chILD) 包含大量不同的疾病，从婴儿期特有的肺发育、成熟和功能障碍，到与成人疾病重叠的免疫介导、环境、血管和其他疾病。肺部的病理学评估在表征许多此类疾病方面发挥了核心作用，从而修订了命名法和分类以帮助指导临床管理(1-4)。技术进步正在迅速揭示这些疾病的遗传和分子基础，并扩大了弥补成人疾病的表型，通常减少了对诊断性肺活检的需求。因此，对儿童进行肺活检的决定通常是为了快速确定危重儿童的疾病，或者当临床表现、影像学和实验室研究无法提供治疗所需的一致诊断时。尽管对肺活检的外科手术进行了修改，以尽量减少术后发病率，但它仍然是一种高风险的侵入性手术，尤其是对于病情复杂的患者(5)。因此，必须正确处理肺活检以最大限度地提高诊断率，包括活检前临床医生、放射科医生、外科医生和病理学家之间的密切沟通，以确定最佳采样部位和组织利用的优先顺序。本综述概述了疑似儿童外科肺活检的最佳处理和评估，重点关注病理特征在提供综合诊断和指导管理方面发挥关键作用的特定情况。
Children's interstitial and diffuse lung disease (chILD) comprises a large number of diverse entities ranging from disorders of lung development, maturation and function unique in infancy to immune‐mediated, environmental, vascular and other conditions overlapping with adult disease. Pathologic evaluation of the lung has played a central role in characterizing many of these disorders, resulting in revised nomenclature and classifications to help guide clinical management(1–4). Technological advancements are rapidly uncovering genetic and molecular underpinnings of these conditions, as well as widening the phenotypes which bridge adult disease, often reducing the perceived need for diagnostic lung biopsy. As such the decision to get a lung biopsy in chILD is frequently for rapid ascertainment of disease in a critically ill child or when clinical presentation, imaging and laboratory studies fail to provide a cohesive diagnosis needed for treatment. While there have been modifications in surgical procedures for lung biopsy that minimize postoperative morbidity, it remains a high‐risk invasive procedure, especially in a medically complex patient(5). Thus, it is essential that the lung biopsy be handled properly to maximize diagnostic yield, including close communication between the clinician, radiologist, surgeon, and pathologist before biopsy to determine best sampling site(s) and prioritization of tissue utilization. This review provides an overview of optimal handling and evaluation of a surgical lung biopsy for suspected chILD, with emphasis on specific conditions in which pathologic features play a critical role in providing an integrated diagnosis and guiding management.