Einfluss der Art der Materialgewinnung auf die Diagnosefindung in der Lungenpathologie

Das Ziel der Arbeit ist die Darstellung der Möglichkeiten der Kryobiopsien für die Diagnostik von Lungenerkrankungen und Pleuraerkrankungen. Es wurde zunächst gezeigt, dass die transbronchialen Kryobiopsien einen deutlichen morphologischen Unterschied gegenüber den konventionellen transbronchialen Biopsien zeigen, indem sie größer sind und häufiger alveoläres Gewebe enthalten. Entnahmebedingte Artefakte des alveolären Gewebes zeigten sich nicht. Untersucht wurden Patientenkollektive mit Krebserkrankungen sowie mit interstitiellen Lungenerkrankungen. In beiden Gruppen zeigt sich eine deutliche Steigerung der diagnostischen Ausbeute. Bei den pleuralen Läsionen konnte mindestens eine Gleichwertigkeit der Methode der Kryobiopsie der Pleura mit einer flexiblen Zangenbiopsie gezeigt werden. Die letzte vorgelegte Arbeit zeigt die erste Beschreibung einer durch Kryobiopsie gesicherten diffusen idiopathischen Hyperplasie der neuroendokrinen Zellen (DIPNECH). Insgesamt zeigt sich eine gute Einsetzbarkeit der Methode bei allen Lungen- und Pleuraerkrankungen.The aim of this work is to present a variety of cryobiopsies for the diagnosis of pulmonary and pleural diseases. The first paper describes a distinct morphologic difference between cryobiopsies and traditional transbronchial biopsies. Cryobiopsies reveal to be larger, contain more common alveolar tissue, which does not show any artefacts. The following analyses included patient groups with cancer and interstitial lung diseases. Both groups show a higher diagnostic yield concerning the specific disease. For the pleural lesions it could be demonstrated that there is at least a diagnostic equivalence between cryobiopsy and flexible thoracosopy. Finally, the last paper is a first case report of a cryobiopsy-diagnosed diffuse idiopathic neuroendocrine cell hyperplasia (DIPNECH). Altogether, the method presents itself suitable for application in all groups of lung and pleural diseases

Morphometrical analysis of transbronchial cryobiopsies

The recent introduction of bronchoscopically recovered cryobiopsy of lung tissue has opened up new possibilities in the diagnosis of neoplastic and non-neoplastic lung diseases in various aspects. Most notably the morphological diagnosis of peripheral lung biopsies promises to achieve a better yield with a high quality of specimens. To better understand this phenomenon, its diagnostic options and perspectives, this study morphometrically compares 15 cryobiopsies and 18 transbronchial forceps biopsies of peripheral lung tissue a priori without considering clinical hit ratio or integration of results in the clinical diagnostic processing. Cryotechnically harvested specimens were significantly larger (mean: 17.1 ± 10.7 mm2 versus 3.8 ± 4.0 mm2) and contained alveolar tissue more often. If present, the alveolar part in cryobiopsies exceeded the one of forceps biopsies. The alveolar tissue of crybiopsy specimens did not show any artefacts. Based on these results cryotechnique seems to open up new perspectives in bronchoscopic diagnosis of lung disease

A Patient with Non-Hodgkin Lymphoma and Nonspecific Interstitial Pneumonia during Ibrutinib Therapy

We present a 74-year-old male with nonspecific interstitial pneumonia (NSIP) during treatment with ibrutinib for mantle cell lymphoma. Previously, the patient had received six cycles of bendamustine and rituximab and six cycles of R-CHOP, followed by rituximab maintenance therapy. Respiratory tract complications of ibrutinib other than infectious pneumonia have not been mentioned in larger trials, but individual case reports hinted to a possible association with the development of pneumonitis. In our patient, the onset of alveolitis that progressed towards NSIP together with the onset of ibrutinib treatment suggests causality. One week after ibrutinib was discontinued, nasal symptoms resolved first. A follow-up CT showed a reduction in the reticular hyperdensities and ground-glass opacities, suggestive of restitution of the lung disease. To our knowledge, this is the first case showing a strong link between ibrutinib and interstitial lung disease, strengthening a previous report on subacute pneumonitis. Our findings have clinical implications because pulmonary side effects were reversible at this early stage. We, therefore, suggest close monitoring for respiratory side effects in patients receiving ibrutinib