Diagnostic criteria and research progress on lung allograft pathology / 器官移植

In recent years, the quantity of lung transplantation has been gradually increased in China along with the accumulation of surgical techniques and postoperative management experience of lung transplantation. Multiple lung allograft complications may occur after lung transplantation, mainly including primary graft dysfunction (PGD) caused by ischemia-reperfusion injury (IRI) of the lung allograft, acute and chronic rejection, opportunistic infection or lymphoproliferative disorder of lymphoid tissues induced by the decrease of host immunity due to postoperative use of immunosuppressants, etc. The diagnosis of complications after lung transplantation mainly relies on biopsy of the lung allograft. In this article, the brief history of lung allograft pathology, main approaches and pathological processing techniques of lung allograft biopsy, major complications after lung transplantation and pathological diagnostic criteria were elucidated, aiming to provide reference for targeted management of these complications in clinical practice.

Diagnosis of peripheral pulmonary lesions using endorbronchial ultrasonography with a guide sheath combination with virtual bronchoscopic navigation / 中国内镜杂志

Objective To assess the diagnosis value of endorbronchial ultrasonography with a guide sheath combination with virtual bronchoscopic navigation at peripheral lung lesions. Methods 23 patients with lung peripheral lesions, 10 cases male, 13 cases female, age 29~78, the median age of 61, were retrospectively analyzed by diagnosised with EBUS-GS-TBLB combination VBN from March 2015 to December 2015. Results 23 cases of patients, 8 cases of adenocarcinoma, squamous carcinoma in 5 cases, mixed carcinoma in 1 case, 1 case of small cell carcinoma and lung metastatic carcinoma in 1 case, 2 cases were tuberculosis, 1 case of inflammation, 4 cases were negative. The total positive rate was 82.6%. Conclusion EBUS-GS-TBLB combination with VBN to the diagnosis of lung lesions with high positive rate, it is worthy of promoting clinically.

Role of a pattern-based approach in interpretation of transbronchoscopic lung biopsy and its clinical implications.

Background. Transbronchial lung biopsy (TBLB) is commonly performed for confirming the tissue diagnosis of diffuse parenchymal lung diseases (DPLDs). There is an urgent need to establish guidelines for interpretation of TBLB in order to improve its diagnostic utility. Methods. We retrospectively studied 916 consecutive patients (494 males; mean age 49 years) who underwent TBLB over a 5-year period (July 2005 to July 2010) at Vallabhbhai Patel Chest Institute. Results. In 615 (67.1%) procedures, material obtained during TBLB was adequate for histopathology interpretation. Pathological features evaluated in each case were: alveolar architecture, inflammatory infiltrate, interstitial fibrosis, atypical cells, pigment deposition, honey-comb change and fibroblast foci. The cases were categorised on the basis of histopathology into six patterns: (1) adequate biopsy without a specific diagnostic abnormality (n=137, 22.3%); (2) acute pneumonitis (n=29, 4.7%); (3) neoplasia (n=109, 17.7%); (4) chronic interstitial inflammation with or without fibrosis (n=138, 22.4%); (5) granulomatous inflammation, (n=186, 30.2%); and (6) other specific causes (n=16, 2.6%). Definitive diagnosis could be made after correlation of TBLB histopathology with clinical and radiological features in 55.3% cases. Conclusions. TBLB appears to be an important diagnostic tool for the diagnosis of DPLDs. The use of a pattern-based approach to TBLB adds to its diagnostic yield and can be helpful in cases where open lung biopsy is not available.

A Case of Secondary Organizing Pneumonia Occurring in Therapy for Lung Abscess / 결핵및호흡기질환

The patient is a 62-year-old man with known diabetes mellitus who presented with a two-weeks-history of dyspnea, cough, and fever. He was diagnosed with a lung abscess in the right upper lobe and was treated with intravenous antibiotics. The patient's clinical and radiological findings improved within seven days after medical treatment. However, newly developed ground-glass opacity and infiltrations were observed in the right lower lung. Fourteen days after admission, the patient's symptoms and imaging finding became aggravated despite trestment with susceptible antibiotics for lung abscess. Trans-bronchial lung biopsy (TBLB) was performed in the lateral basal segment of the right lower lobe of the lung. A histologic photomicrograph showed organizing pneumonia, also called bronchiolitis obliterans with organizing pneumonia(BOOP), that became more definite as the terminal bronchioles and alveoli became occluded with masses of inflammatory cells and fibrotic tissue. The clinical symptoms and radiograph findings resolved quickly with prednisone treatment. We report a case of secondary organizing pneumonia diagnosed after TBLB following lung abscess treatment and provide a review of the literature.

Diagnosis of 101 Cases of Unknown Lung Mass / 中国医师杂志

Objective To explore the diagnostic value of transbronchial lung biopsy(TBLB), CT-guided percutaneous lung biopsy and sputum cytology for unknown lung mass. Methods The clinical data of 101 inpatients with unknown lung mass were retrospectively analyzed. Results Among the 101 cases, 73 cases underwent fibrous bronchoscopic examination, 18 cases underwent CT-guided percutaneous lung biopsy, and 10 cases underwent both of them.The diagnostic coincident rate of the two methods was 70%. 54 cases were diagnosed lung carcinoma by pathology. The sensitivity and specificity of TBLB for diagnosing central type of tumor were 88% and 100%, respectiely, and those for diagnosing peripheral type of tumor were 43% and 100%, respectively. The sensitivity of CT-guided percutaneous lung biopsy was 80%,while the specificity was 100%. Complication frequency in the CT-guided percutaneous lung biopsy was 22%, and much higher than that (12%) in the TBLB. Only 30% cases underwent sputum cytology examination, and the positive rat was 6%. Conclusion Sputum cytologic examination is a convenient and cheap method, but its diagnostic rate is relatively low. TBLB was the first choice for examining central type of lung mass. For the peripheral type of lung mass, examination method was selected based on the location and size of the mass.

The Clinical Usefulness of Transbronchial Lung Biopsy in Critically Ill Patients with Pulmonary Infiltrates of Uncertain Etiology / 결핵

BACKGROUND: Transbronchial lung biopsy (TBLB) has known to yield useful information for pulmonary infiltrates of uncertain etiology. However, the its safety and usefulness of TBLB has have not been conclusive in the critically ill patients with respiratory failure. Moreover, TBLB has not been recommended for patients with mechanical ventilation. This study was done conducted to investigate the diagnostic values and risks of TBLB performed on critically ill patients at bedside to obtain information on the pulmonary infiltrate of unknown etiology. METHODS: Twenty patients (21 admissions with 23 cases) with diffuse pulmonary infiltrates who were treated in a medical intensive care unit of a tertiary referral hospital from January 1994 to May 1998, were enrolled for this study. Their medical records were retrospectively reviewed. TBLB was opted when a noninvasive diagnostic work-up failed to reveal the cause for the pulmonary infiltrate. The procedure was performed at patients' bedside without assistance of fluoroscopy. Bronchial washing or bronchoalveolar lavage was performed on the same pulmonary segment before performing TBLB. RESULTS: Adequate specimens were obtained in 18 cases (78%). TBLB provided specific diagnosis in two cases. The results of TBLB suggested the underlying etiology in 9 cases; bacterial pneumonitis (4), hypersensitivity pneumonitis (1), polymyositis (1), radiation fibrosis (1), idiopathic pulmonary fibrosis (1), and BOOP (1). Therapeutic decisions were altered in 11 cases (47.8 %) based on the TBLB results. Pneumocystis carinii was found in the BAL fluid of another case. Ten patients with a therapeutic change and ten patients without a management change had mortality rates of 40% and 80%, respectively. The APACHE III scores were significantly higher in patients with complications (72.8+/-21.8) compared with those without complications (48.3+/-18.9) (p< 0.05). The complication rates were higher in those with mechanical ventilation (50 %) than in those without mechanical ventilation (33 %)(,) but the difference was not statistically significant (p= 0.3). Conclusions: TBLB may be a useful diagnostic option for critically ill patients with unknown cause of pulmonary infiltrates. However, it should be be used with care for patients with mechanical ventilation or for severely ill patients.