考えられる特発性間質性肺炎における経気管支病理に基づく集学的分類の意義

The significance of multidisciplinary classifications based on transbronchial pathology in possible idiopathic interstitial pneumonias.

• Weixue Wang
• Jian Xu
• Chunfang Liu
• Ruie Feng
• Junjun Zhao
• Na Gao
• Ling Jiang
• Xiaolin Zhang
• Xue Han
• Lina Ren
• Xiaohui Zhao
• Yuan Liu

抄録

特発性間質性肺炎（IIPs）の診断には、外科的肺生検がゴールデンスタンダードとされている。ここでは、経気管支肺クリオバイオプシー（TBLC）、気管支肺胞ラバージ液（BALF）、経気管支超音波ガイド下経気管支針吸引生検（EBUS-TBNA）を含む経気管支病理学的分類による診断精度を示すことを試みた.2016年6月1日から2018年12月31日までに入院した間質性肺疾患が疑われる患者が対象となった。間質性肺疾患の原因が既知で、臨床、放射線情報により診断された典型的な特発性肺線維症の患者は除外した。非定型特発性肺線維症およびIIPの可能性のある患者は、経気管支病理学的評価を受け入れた。初期の集学的診断（MDD）は、集学的チーム（Multidisciplinary team: MDT）により、臨床情報、放射線学的情報、経気管支病理学的情報に基づいて分類された。最終的なMDD分類は、その後の治療効果によって確認された。すべての患者は少なくとも6ヶ月間フォローアップされ、合計70人の患者が最終的に関与した。最終的に70人の患者が参加した。TBLCで抽出した肺実質のサンプルは68.6%(48/70人)の症例で病理診断を確認するのに十分なものであった。EBUS-TBNAでは6例が抽出された。BALFで細菌学的診断が陽性となったのは1例であった。病理診断はTBLC，EBUS-TBNA，BALFで77.1％（54/70例）であった．フォローアップ試験では、肺病変の改善は60％、グルココルチコイドの少量減量・休薬時の再発は11.43％、平準化は14.29％、進行は8.57％であった。臨床的特徴が進行した4例の診断を修正した。その結果、経気管支病理学に基づく初期MDD分類は94.3％が最終MDDと一致し、診断収率の差は初期MDDと最終MDDの間で有意ではなかった（Z"Zs_200A"="Zs_200A"-1.414、P"Zs_200A"="Zs_200A".157）。

Surgical lung biopsy is regarded as the golden standard for the diagnosis of idiopathic interstitial pneumonias (IIPs). Here, we attempted to show the diagnostic accuracy of multidisciplinary classifications based on transbronchial pathology including transbronchial lung cryobiopsy (TBLC) , bronchoalveolar lavage fluid (BALF) and endobronchial ultrasound-guided transbronchial needle aspiration biopsy (EBUS-TBNA).Patients with suspected interstitial lung diseases admitted from June 1, 2016 to December 31, 2018 were involved. Patients with known causes of interstitial lung diseases and typical idiopathic pulmonary fibrosis diagnosed through clinical, radiological information were excluded. Patients with atypical idiopathic pulmonary fibrosis and possible IIPs accepted transbronchial pathological evaluation. Initial multidisciplinary diagnosis (MDD) classifications were made depending on clinical, radiological and transbronchial pathological information by a multidisciplinary team (MDT). The final MDD classifications were confirmed by subsequent therapeutic effects. All patients were followed up for at least 6 months.A total of 70 patients were finally involved. The samples of lung parenchyma extracted through TBLC were enough for confirmation of pathological diagnoses in 68.6% (48/70) cases. Samples of 6 cases were extracted by EBUS-TBNA. Bacteriological diagnoses were positive in 1 case by BALF. Pathological diagnoses of 77.1% (54/70) cases were achieved through TBLC, EBUS-TBNA and BALF. During the follow up study, the pulmonary lesions of 60% patients were improved, 11.43% were relapsed when glucocorticoid was reduced to small dose or withdrawal, 14.29% were leveled off and 8.57% were progressed. The diagnoses of 4 patients with progressed clinical feature were revised. As a result, 94.3% initial MDD classifications based on transbronchial pathology were consistent with the final MDD, and the difference of diagnostic yield wasn't significant between initial and final MDD (Z = -1.414, P = .157).Classifications of IIPs based on transbronchial pathology were useful and quite agreed with final MDD.