医学
指南
分级(工程)
放射科
肺
不利影响
梅德林
肺活检
活检
重症监护医学
内科学
病理
土木工程
政治学
法学
工程类
作者
Daniël A. Korevaar,Sara Colella,Markus Fally,Juliette Camuset,Thomas V. Colby,Lars Hagmeyer,Juergen Hetzel,Fabien Maldonado,António Morais,Claudia Ravaglia,René Spijker,Sara Tomassetti,Lauren Troy,Johny Verschakelen,Athol U. Wells,Thomy Tonia,Jouke T. Annema,Venerino Poletti
出处
期刊:The European respiratory journal
[European Respiratory Society]
日期:2022-06-16
卷期号:60 (5): 2200425-2200425
被引量:60
标识
DOI:10.1183/13993003.00425-2022
摘要
Background In patients with interstitial lung diseases (ILD), histopathological input is often required to obtain a diagnosis. Surgical lung biopsy (SLB) is considered the reference standard, but many patients are clinically unfit to undergo this invasive procedure, and adverse events, length of hospitalisation and costs are considerable. This European Respiratory Society (ERS) guideline provides evidence-based clinical practice recommendations for the role of transbronchial lung cryobiopsy (TBLC) in obtaining tissue-based diagnosis in patients with undiagnosed ILD. Methods The ERS Task Force consisted of clinical experts in the field of ILD and/or TBLC and methodological experts. Four PICO (Patient, Intervention, Comparator, Outcomes) questions and two narrative questions were formulated. Systematic literature searches were performed in MEDLINE and Embase (up to June 2021). GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology was applied. Results In patients with undiagnosed ILD and an indication to obtain histopathological data: 1) TBLC is suggested as a replacement test in patients considered eligible to undergo SLB, 2) TBLC is suggested in patients not considered eligible to undergo SLB, 3) SLB is suggested as an add-on test in patients with a non-informative TBLC, 4) no recommendation is made for or against a second TBLC in patients with a non-informative TBLC and 5) TBLC operators should undergo training, but no recommendation is made for the type of training required. Conclusions TBLC provides important diagnostic information in patients with undiagnosed ILD. Diagnostic yield is lower compared to SLB, at reduced serious adverse events and length of hospitalisation. Certainty of the evidence is mostly “very low”.
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