Supplementary Material for: Clinical application of confocal laser endomircoscopy combined with cryobiopsy in the diagnosis of interstitial lung disease

Background: Confocal laser endomicroscopy (CLE) has the characteristics of high resolution, real-time imaging and no radiation, which is helpful for the precise and effective implementation of transbronchial cryobiopsy (TBCB). Objectives: The study aimed to compare the efficacy and safety of TBCB combined with CLE (CLE group) or fluoroscopy (fluoroscopy group) in the diagnosis of interstitial lung disease (ILD). Method: From a prospective randomized controlled trial, eighty patients with undiagnosed ILD or ILD requiring biopsy between January 2022 and November 2022 were randomly assigned to CLE group and fluoroscopy group. The rate to reach an etiological diagnosis of ILD, maximum cross-sectional area of specimens, operation time and complications were compared between the two groups. Results: The rate to reach an etiological diagnosis in the CLE group was significantly higher than that in the fluoroscopy group (95.0% vs 80.0%, p<0.05), but there was no difference in the maximum cross-sectional area of the specimens (42.1±10.1 mm2 vs 41.5±10.3 mm2, p>0.05). In terms of operation time, the CLE group was significantly shorter than the fluoroscopy group (37.6±10.6 min vs 54.8±24.9 min, p<0.05). The bleeding volume in the CLE group was significantly lower than that in the fluoroscopy group (4.9±3.6 ml/case vs 9.0±9.2 ml/case, p<0.05). Further analysis showed that the incidence of moderate bleeding was also lower in the CLE group (20.0% vs 75.0%, p<0.001). In addition, the incidence of pneumothorax in the CLE group was significantly lower than that in the fluoroscopy group (0 vs 25.0%, p<0.001). Conclusions: Compared with simple fluoroscopy, the combination of CLE significantly improves the rate of etiological diagnosis, shortens the operation time, and reduces complications such as bleeding and pneumothorax.

背景：共聚焦激光内镜（Confocal laser endomicroscopy, CLE）具备高分辨率、实时成像且无辐射的特性，有助于精准且高效地开展经支气管镜冷冻活检（Transbronchial cryobiopsy, TBCB）。
研究目的：对比经支气管镜冷冻活检联合共聚焦激光内镜（CLE组）与单纯透视引导（透视组）在诊断间质性肺疾病（Interstitial lung disease, ILD）中的有效性与安全性。
方法：本研究数据来自一项前瞻性随机对照试验，纳入2022年1月至2022年11月期间80例确诊不明或需活检的间质性肺疾病患者，随机分配至CLE组与透视组。比较两组患者的间质性肺疾病病因诊断达成率、标本最大横截面积、手术时长及并发症发生情况。
结果：CLE组的间质性肺疾病病因诊断达成率显著高于透视组（95.0% vs 80.0%，p<0.05），但两组标本最大横截面积无显著差异（42.1±10.1 mm² vs 41.5±10.3 mm²，p>0.05）。手术时长方面，CLE组显著短于透视组（37.6±10.6 min vs 54.8±24.9 min，p<0.05）。CLE组的失血量显著低于透视组（4.9±3.6 ml/例 vs 9.0±9.2 ml/例，p<0.05）。进一步分析显示，CLE组中度出血发生率同样更低（20.0% vs 75.0%，p<0.001）。此外，CLE组气胸发生率显著低于透视组（0 vs 25.0%，p<0.001）。
结论：与单纯透视引导相比，联合共聚焦激光内镜可显著提升间质性肺疾病的病因诊断达成率，缩短手术时长，并降低出血、气胸等并发症的发生风险。