Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Interstitial Lung Disease.
Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Interstitial Lung Disease.
复制标题
DOI：
10.1007/s00408-020-00389-4
复制
发表时间：
2020-10
期刊：
影响因子：
5
通讯作者：
Glazer CS
中科院分区：
文献类型：
--
作者：
Adams TN;Batra K;Silhan L;Anand V;Joerns EK;Moore S;Butt YM;Torrealba J;Newton CA;Glazer CS
支气管肺泡灌洗和经支气管活检是评估间质性肺病（ILD）的有用工具，但该手术的患者选择仍不明确。确定有助于选择患者进行支气管镜检查的临床特征可能会提高ILD分类的置信度，同时限制与手术肺活检相关的潜在不良结局。本研究的目的是确定合并BAL和TBBx数据前后与多学科ILD诊断（MDD）变化相关的因素。我们对在ILD诊断性检查中接受支气管镜检查的单个中心ILD患者进行了一项回顾性队列研究。我们在支气管镜检查前后进行了连续MDD，以计算合并BAL和TBBX信息后诊断变化的频率，并确定与诊断变化相关的特征。245名患者被纳入研究。支气管镜检查导致58例患者（23.7%）的诊断改变。在BAL中添加TBBx使诊断率从21.8%增加至34.1%（p = 0.027）。抗原鉴定、HRCT扫描与UIP不一致以及支气管镜检查前未诊断为CTD-ILD或IPAF与支气管镜检查后诊断的变化相关。我们的研究提示了可能有助于选择患者进行支气管镜检查的临床特征。我们建议在抗原确定或HRCT诊断与非IPF诊断一致的患者中进行支气管镜检查。选择适当的患者进行支气管镜检查可以提高ILD诊断的信心，避免更具侵入性和风险更高的操作的潜在并发症。
Bronchoalveolar lavage and transbronchial biopsy can be a useful tool in the evaluation of interstitial lung disease (ILD), but patient selection for this procedure remains poorly defined. Determining clinical characteristics that help with patient selection for bronchoscopy may improve confidence of ILD classification while limiting potential adverse outcomes associated with surgical lung biopsy. The purpose of this study is to identify factors that were associated with change in multidisciplinary ILD diagnosis (MDD) before and after incorporation of BAL and TBBx data. We conducted a retrospective cohort study of ILD patients at a single center who underwent bronchoscopy in the diagnostic workup of ILD. We performed sequential MDD both pre- and post-bronchoscopy to calculate the frequency of change in diagnosis after incorporating information from BAL and TBBx and identify features associated with change in diagnosis. 245 patients were included in the study. Bronchoscopy led to a change in diagnosis in 58 patients (23.7%). The addition of TBBx to BAL increased diagnostic yield from 21.8 to 34.1% (p = 0.027). Identification of antigen, HRCT scan inconsistent with UIP, and absence of a pre-bronchoscopy diagnosis of CTD-ILD or IPAF were associated with a change in diagnosis after bronchoscopy. Our study suggests clinical features that may assist with patient selection for bronchoscopy. We suggest bronchoscopy in patients with identified antigen or an HRCT that is consistent with a non-IPF diagnosis. Appropriate patient selection for bronchoscopy may improve ILD diagnostic confidence and avoid potential complications from more invasive and higher risk procedures.
登录
查看更多内容
DOI：
10.1164/rccm.200301-137oc
发表时间：
2003-10-15
影响因子：
24.7
作者：
Lacasse, Y;Selman, M;Cormier, Y
通讯作者：
Cormier, Y
影响因子：
76.2
作者：
Troy, Lauren K.;Grainge, Christopher;Lau, Edmund M. T.
通讯作者：
Lau, Edmund M. T.
DOI：
10.1164/rccm.200808-1313oc
发表时间：
2009-06-01
影响因子：
24.7
作者：
Ohshimo, Shinichiro;Bonella, Francesco;Costabel, Ulrich
通讯作者：
Costabel, Ulrich
影响因子：
3.7
作者：
Jin, Faguang;Mu, Deguang;Liu, Tonggang
通讯作者：
Liu, Tonggang
影响因子：
9.6
作者：
Salisbury, Margaret L.;Gu, Tian;Flaherty, Kevin R.
通讯作者：
Flaherty, Kevin R.