纤维支气管镜肺活检诊断弥漫性肺疾病160例临床分析

目的 探讨纤维支气管镜肺活检用于诊断弥漫性肺疾病(DLD)的应用价值和安全性.方法 回顾性分析我院近10年160例DLD患者接受支气管镜肺活检(TBLB)的临床和病理诊断资料.结果 160例DLD患者中行TBLB确诊49例(30.63%),病理诊断包括其中特发性间质性肺炎18例,肺部恶性肿瘤10例,肺结核6例,结缔组织病相关DLD 4例,结节病3例,嗜酸性细胞性肺炎2例,放射性肺炎、机化性肺炎、气道淀粉样变、肺泡蛋白沉积症、肺淋巴管肌瘤病各1例,其他不能归类间质性肺炎1例;女性患者明显多于男性(92 vs 68,P<0.01),DLD中特发性间质性肺炎最多,TBLB其术后并发症少,术后肺功能无明显变化.结论 TBLB是诊断DLD的安全有效的方法,对DLD的鉴别诊断具有重要意义.     

经纤维支气管镜肺活检对弥漫性间质性肺疾病的诊断价值

目的探讨经纤维支气管镜肺活检（TBLB）对弥漫性间质性肺疾病（D ILD）的诊断价值。方法报道168例D ILD患者,其中行TBLB病理检查确诊45例（26.79%）,分析患者性别、病理诊断构成比及误诊情况等。结果 45例患者中,误诊为非特异性肺炎8例,肺结核6例,肺癌5例,肺淋巴瘤4例,肺动脉高压3例,气道中心纤维化2例;女性患者明显多于男性（27 vs 18,P〈0.01）。D ILD患者中特发性间质性肺炎最多（32例）,其次是结缔组织病相关D ILD（8例）、结节病（5例）。结论 TBLB是诊断D ILD的有效手段,对D ILD的鉴别诊断和分类诊断有重要意义。     

经支气管镜肺活检对弥漫性肺间质性疾病的诊断价值及文献复习

目的探讨经支气管镜肺活检（TBLB）对弥漫性肺间质性疾病（DILD）的诊断价值。方法对71例DILD患者在无X线电视透视下行TBLB,并对临床资料及病理诊断结果进行回顾性分析。结果 71例DILD中22例明确诊断,确诊率达31.0%,确诊的疾病种类主要有肺结核7例（31.8%）,普通型间质性肺炎5例（22.7%）,肺泡细胞癌4例（18.2%）,转移性肺癌2例（9.1%）,肺真菌病1例（4.5%）结节病1例（4.5%）,肺泡微石症1例（4.5%）,隐原性机化性肺炎1例（4.5%）;临床诊断病例共31例,诊断率达43.7%,其中特发性肺纤维化15例（48.4%）,结缔组织病相关肺疾病11例,弥漫性泛细支气管炎2例（6.5%）,癌性淋巴管炎2例（6.5%）,炎性假瘤1例（3.2%）;未能明确诊断18例（25.4%）。结论 TBLB对DILD的诊断是一种安全、简便、有效的方法,特别是在除外结节病、肿瘤和某些特殊类型的感染（结核）有重要价值。肺间质性疾病的病理诊断特别是病理分型需要较大的组织,必要时可行胸腔镜（VATS）肺活检或开胸肺活检,以提高对DILD的诊断水平。     

CT引导下经皮肺穿刺在肺弥漫性病变中诊断价值

目的评价CT引导下经皮肺穿刺在肺弥漫性病变中的诊断价值。方法应用16 GBARD活检针穿刺32例肺部弥漫性病变患者,主要影像学改变包括弥漫性网格样结节或结节影,网状线形阴影和弥漫性磨玻璃影。结果 32例患者均取材成功,并获得明确诊断,10例恶性肿瘤,(其中5例肺泡癌,5例肺癌肺内转移),22例良性病变(7例粟粒性肺结核,7例间质性肺炎,2例肺泡蛋白沉积征,2例肺真菌病,1例闭塞性支气管炎伴机化性肺炎,1例肺结节病,1例过敏性肺炎,1例弥漫性泛细支气管炎)。主要并发症是气胸(22.5%)和出血(21.9%)。结论 CT引导下经皮肺穿刺是一种实用、安全、并发症低的技术,对弥漫性肺疾病有很高的确诊率。     

经支气管镜肺活检病理证实隐源性机化性肺炎临床分析

隐源性机化性肺炎（COP）是一类以临床病理命名的间质性肺炎，COP是1985年Epler等^[1]提出的病理表现为肺泡内、肺泡管、呼吸性细支气管及终末细支气管腔内有肉芽组织形成的独立病种，又称特发性闭塞性细支气管炎伴机化性肺炎（IBOOP），近20年来报道逐渐增多，易与肺部感染、结核、肿瘤、结节病、其他间质性肺疾病等混淆，现将我院2007年至2008年收治的支气管镜肺活检（TBLB）获得病理证实的8例病例分析如下。     

开胸肺活检对肺间质疾病的诊断价值

目的探讨开胸肺活检对肺间质疾病的诊断作用。方法对１９９３～１９９８年６月２４例开胸肺活检的肺间质疾病患者进行回顾性分析。结果２４例患者均获病理确诊,其中普通型间质性肺炎（ＵＩＰ）７例,闭塞性细支气管炎伴机化性肺炎（ＢＯＯＰ）３例,结节病３例,弥漫性泛细支气管炎（ＤＰＢ）２例,肺结核２例。其他急性间质性肺炎（ＡＩＰ）、呼吸性细支气管炎伴肺间质病（ＲＢＩＬＤ）、肺组织细胞增生症Ｘ、炎性结节、多发性肺脓肿、肺组织炎症和肺泡细胞癌各１例。结论开胸肺活检作为一种诊断方法,能获得足够的肺组织,具有很高的敏感性和特异性,能明确病变的部位和程度。对常规和纤维支气管镜未能确诊的病例,尤其是一些罕见病和不典型的病例,具有较大的价值。     

肺泡蛋白沉积症84例误诊误治分析

目的 提高肺泡蛋白沉积症(PAP)临床诊治水平.方法 回顾性分析北京协和医院1990年1月至2007年10月确诊的PAP患者在院内外的误诊、误治过程,分析其原因.结果 84例PAP患者平均诊断周期14.5个月.入院前67%患者存在误诊.近年来误诊为肺结核者减少,误诊为特发性间质性肺炎者增多.PAP患者在院外行支气管镜、肺泡灌洗(BAL)及经支气管肺活检(TBLB)的比例低,患者是否行BAL及TBLB检查与其是否误诊相关.87%的患者通过支气管镜、BAL及TBLB确诊.33.3%的患者在院外曾接受糖皮质激素治疗,经激素治疗的患者有6例合并严重感染,2例死亡.结论 PAP患者误诊误治仍很普遍,误诊考虑可能与支气管镜、BAL、TBLB检查比例低有关.应重视PAP的影像学特征,积极行支气管镜、BAL、TBLB检查,避免误诊.诊断不明确时务必慎用激素.     

173例经支气管镜冷冻肺活检在弥漫性肺疾病中的病理诊断分析

目的 探讨经支气管镜冷冻肺活检技术(TBCB)对肺部弥漫性疾病(DLD)病理诊断的价值.方法 收集广州医科大学附属第一医院2017年1月-2019年6月173例病因诊断不明需行TBCB检查的住院患者的临床病理资料,进行回顾性分析及总结,其中54例同时行TBCB和常规经支气管镜肺活检(TBLB),比较两者活检方法标本大小及病理诊断效率.结果 173例TBCB标本中,结合患者年龄、性别、职业、既往史、接触史、吸烟史、实验室血清学及影像学结果,最终病理组织学检查明确分型者有148例(85.5%),病理明确分型或有提示诊断者160例(92.5%),其中已知病因为72例(45.0%);特发性间质性肺炎27例(16.9%);7例肉芽肿性病变(4.4%);其他类型54例(33.8%).173例中54例同时行TBCB和TBLB,TBCB组和TBLB组标本的大小分别为(3.3±1.3)和(1.0±0.3) mm2(t'=12.67,P<0.01).TBCB组和TBLB组明确病理分型诊断效率分别为81.5%(44/54)和42.6%(23/54),差异有统计学意义(X2=17.33,P<0.01).其中TBCB组与TBLB组对间质性肺疾病明确分型的病理诊断效率分别为48.2% (26/54)和5.6%(3/54),差异有统计学意义(X2=24.94,P<0.01).而TBCB组与TBLB组诊断除间质性肺疾病以外的其他弥漫性肺疾病的病理诊断效率分别为33.33%(18/54)和37.04%(20/54),差异无统计学意义(x2=0.1624,P=0.687).结论 与TBLB相比较,TBCB所获得的标本大小及在确诊弥漫性肺疾病特别是间质性肺疾病分型上具有明显优势和应用价值.     

经支气管镜肺活检对弥漫性肺间质性疾病的诊断价值

目的探讨经纤维支气管镜肺活检（TBLB）对弥漫性肺间质性疾病的诊断价值。方法51例弥漫性肺问质性疾病患者,在无X线电视透视下行TBLB,对临床资料及病理诊断结果进行分析。结果51例弥漫性肺疾病中有16例明确了病因学诊断,确诊率达31．4％。临床诊断病例共28例,诊断率达54．9％,未能明确诊断7例（13．7％）。结论纤维支气管镜肺活检对弥漫性肺间质性疾病的诊断是一种可靠、安全、简便、经济的方法,特别是在弥漫性肺疾病诊断中除外结节病、肿瘤和某些特殊类型的感染有重要价值。     

外科肺活检在特发性间质性肺炎诊断中的应用

特发性间质性肺炎（idiopathic interstitial pneumonia，IIP）是一组原因不明的弥漫性实质性肺疾病（DPLD），包括7种临床病理类型，发病频率分别是（临床诊断／病理诊断）：特发性肺纤维化（IPF）／普通型间质性肺炎（UIP）、非特异性间质性肺炎（NSIP）／NSIP、隐源性机化性肺炎（COP）／机化性肺炎（OP）、急性间质性肺炎（AIP）／弥漫性肺泡损伤（DAD）、呼吸性细支气管炎伴间质性肺疾病（RB—ILD）／呼吸性细支气管炎（RB）、脱屑性间质性肺炎（DIP）／DIP、淋巴细胞间质性肺炎（LIP）／LIP。IIP上述临床病理类型的确诊需要肺活检病理，在很多情况下往往需要外科肺活检。小开胸肺活检的诊断率高，     

A comparative study of the prognosis for Japanese patients with idiopathic interstitial pneumonia or BOOP based on histopathologic subsets]

We explored the prognosis for 123 patients with either idiopathic interstitial pneumonia (IIP) or bronchiolitis obliterans organizing pneumonia (BOOP). All patients underwent either open lung biopsy or thoracoscopic lung biopsy procedures. The histopathologic diagnosis of IIP included patients with usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), and desquamative interstitial pneumonia with respiratory bronchiolitis-associated interstitial lung disease. The prognosis was poorest for patients with a histologic diagnosis of UIP, and excellent for those who received a diagnosis of BOOP. Although the prognosis is generally considered to be good for patients with NSIP, some NSIP patients in our study died. Histopathologic diagnosis based on surgical lung biopsy is useful in evaluating the prognosis for patients with IIP.     

Clinico-pathological study of collagen-related pulmonary lesions in cases of open lung biopsy]

We studied the clinico-pathological correlation of collagen disease-related pulmonary lesions to examine the pathological and radiological features of collagen lung, and the effect of steroid therapy. Ten open lung biopsy cases were examined; 4 male, and 6 female. The mean age was 55 years old. Seven cases developed pulmonary shadows after the diagnosis of collagen disease, and 3 cases showed pulmonary shadow prior to diagnosis. Pathologically, 6 cases proved to be bronchiolitis obliterans organizing pneumonia (BOOP), 3 cases were chronic interstitial pneumonia (UIP), and 1 case was acute interstitial pneumonia. All cases had inflammatory thickening of the interstitium involving the pleura, bronchial wall, and perivascular connective tissue. Half of the cases had bronchiolar inflammatory lesions. Radiologically BOOP cases showed either localized ground glass shadows, or diffuse reticulonodular shadows predominantly in the lower lung fields with shrinkage of affected areas. UIP cases showed reticulonodular shadows, and active UIP cases showed overlapping ground glass shadows. Steroids were administered in cases of BOOP and active UIP, and all cases showed improvement. We consider that open lung biopsy is of use in the diagnosis of some cases and in assessing whether steroid therapy is indicated.     

Saliva production in patients with diffuse lung disease]

We explored the potential involvement of Sj?gren's syndrome as a cause of diffuse lung disease. A prospective clinical study was performed with measurements of saliva production made using the Saxon test. Sixty-seven diffuse lung disease patients who did not exhibit xerosis were examined. The group included 43 patients with sarcoidosis, 11 with interstitial pneumonia, 3 with primary pulmonary lymphoma (PPL), 2 with idiopathic BOOP, 2 with chronic eosinophilic pneumonia, and 6 with other diseases. Decreased saliva production was detected in 11 (16.4%), and Sj?gren's syndrome was diagnosed in 4 (6.0%). Lung lesions displayed by the group with Sj?gren's syndrome included PPL, bronchiolitis, sarcoidosis, and interstitial pneumonia. We concluded that in patients with diffuse lung diseases, it is always important to discriminate between those with sicca syndrome and Sj?gren's syndrome. In our study, the Saxon test proved highly effective as a screening procedure for this purpose.     

Lesion with morphologic feature of organizing pneumonia (OP) in CT-guided lung biopsy samples for diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP): a retrospective study of 134 cases in a single center

Background

Small biopsy samples are generally considered inconclusive for bronchiolitis obliterans organizing pneumonia (BOOP) diagnosis despite their potential to reveal organizing pneumonia (OP) pathologically, necessitating risky invasive tissue biopsy during surgery for reliable confirmation.

Objective

OP by CT-guided lung biopsy was to evaluate the role in the diagnosis of BOOP.

Methods

A retrospective review of 134 cases with the OP feature in the CT-guided lung biopsy samples between 2004 and 2011 at a single center was conducted. Diagnostic accuracy of OP by CT-guided lung biopsy and clinical-radiographic data alone were compared.

Results

After exclusion of 11 cases due to pathology with others besides OP and 15 cases for loss to follow-up, 108 were included. Of these, 95 cases and 13 cases were classified as BOOP and non-BOOP group, respectively. Among BOOP group, only 30 were initially diagnosed as BOOP according to the typical clinical and radiographic features. The other 65 cases with atypical features were diagnosed as BOOP mainly based on OP by CT-guided lung biopsy. Among non-BOOP group, one was misdiagnosed as BOOP, and others were not BOOP according to clinical and radiographic findings. Thus, OP by CT-guided lung biopsy produced a diagnostic accuracy of 87.96% (95/108), much higher than 31.25% (30/96) observed using clinical and radiographic data alone. Combined, these techniques produced diagnostic accuracy of 98.96% (95/96).

Conclusions

OP by CT-guided lung biopsy can be effectively used as the pathological evidence for BOOP diagnosis and reducing unnecessary surgery.     

How are interstitial lung diseases diagnosed in Germany? Results of the scientific registry for the exploration of interstitial lung diseases ("Fibrosis registry") of the WATL

From 1995 to 1999 we evaluated questionnaires sent by pulmonologists and departments of pulmonology in order to register interstitial lung diseases. On the whole 1142 patients (579 males, 563 females, mean age 51.1 +/- 15.3 years, sarcoidosis, n = 511, extrinsic allergic alveolitis, n = 145, idiopathic pulmonary fibrosis, n = 308, bronchiolitis obliterans organizing pneumonia (BOOP), n = 93, others, n = 85) were recorded in the registry. With reference to the mean age sarcoidosis occurred most frequently in the fourth decade and idiopathic pulmonary fibrosis in the sixth decade. In all these diseases bronchoscopy with bronchoalveolar lavage and transbronchial biopsy was predominantly used for further diagnosis. It was striking that high-resolution computed tomography of the thorax was still rarely used when diagnosing these diseases. Apart from the group with BOOP the number of non-smokers in men and women was decisively higher than the average of the population of Germany.