サルコイドージスに対する経気管支肺生検 (TBLB) の実施状況とその診断学的意義に関する検討

抄録

270 patients with sarcoidosis underwent transbronchial lung biopsy (TBLB) at 25 hospitals in Japan between 1973 and July, 1980.
The frequency of non-caseating epithelioid cell granulomas in the specimens obtained by the TBLB was correlated with the stages of chest radiographic changes, and was not correlated to the selected biopsy site among stage I patients, the presence or absence of a past history of corticosteroid treatment or of extrathoracic lesions, the strength of Mantoux reaction and the level of serum γ-globulin.
The epithelioid cell granulomas were recognized in the histological specimens obtained by TBLB: in one of 10 patients at stage 0(10%), in 42 of 101 patients at stage I (42%), in 88 of 119 patients at stage II (74%), and in 24 of 40 patients at stage III (60%).
The frequency of the epithelioid cell granulomas in specimens obtained by the TBLB from the stage I patients was maximal (65%) when three specimens were obtained. The frequency in specimens obtained by TBLB was comparable to the results of the scalene lymph node biopsy in stage II and III patients.
Complications due to the TBLB occured in 27 patients (10%): pneumothoraces in 13, bleeding in 13, and chest pain in one patient but most did not require treatment.
In consideration of the ease, safety and accuracy of histological examination results, TBLB would be the first diagnostic procedure of choice for histopathological diagnosis in most cases suspicious of sarcoidosis.