間質性肺疾患の診断における共焦点レーザー内視鏡ガイド下凍結生検

実験的：pCLE-guided group

Patients assigned to this group undergo transbronchial lung cryobiopsy (TBLC) with probe-based confocal laser endomicroscopy (pCLE) guidance. Before bronchoscopy, the target lobe and bronchial segment are determined according to high-resolution computed tomography findings and multidisciplinary evaluation. During the procedure, pCLE is performed within the predefined target region to assess the distal lung parenchyma and assist in selecting an appropriate biopsy site. The pCLE probe is advanced into the distal lung parenchyma for assessment. After pCLE evaluation, TBLC is performed with the cryoprobe positioned approximately 1-2 cm from the pleura. Areas considered suitable for tissue sampling are preferentially selected while potentially unfavorable regions are avoided when feasible. After pCLE assessment, the probe is withdrawn and TBLC is performed at the selected site according to standard procedures.

手順：pCLE-guided transbronchial lung cryobiopsy

Probe-based confocal laser endomicroscopy is used before TBLC to assist biopsy-site selection within the predefined target region.

実験的：Fluoroscopy-guided TBLC

Patients assigned to this group undergo fluoroscopy-guided transbronchial lung cryobiopsy (TBLC). Before bronchoscopy, the target lobe and bronchial segment are determined according to high-resolution computed tomography findings and multidisciplinary evaluation. TBLC is performed within the predefined target region in accordance with published international expert consensus recommendations. Biopsy specimens are subsequently evaluated by histopathology and multidisciplinary discussion.

手順：Fluoroscopy-guided transbronchial lung cryobiopsy

TBLC is performed at biopsy sites selected according to conventional clinical and radiological assessment without pCLE guidance.

MDD diagnostic yield after TBLC

MDD diagnostic yield after TBLC, defined as the proportion of participants with a specific final diagnosis established by post-biopsy MDD.

Occurrence of operation-related complications

Final diagnostic categories, biopsy specimen characteristics, bleeding severity and volume, hemostatic interventions, pneumothorax, and mortality within 7 days after TBLC.