我们评估了透射电子显微镜 (TEM) 在经支气管肺冷冻活检 (TBLC) 样本中的效用，这些样本取自 16 名连续接受纤维化间质性肺疾病 (ILD) 常规评估的患者。除了常规病理学检查之外，还制备了 1 至 2 个 TBLC 样本用于 TEM 分析，并使用 Zeiss LEO EM 910 进行评估。胸膜下冷冻活检和来自非 ILD 肺癌患者新鲜肺叶切除组织的未冷冻切除活检作为对照。与对照相比，TEM 提供了仅存在少量冷冻伪影的高质量图像。此外，在几名 ILD 患者中，我们发现了明显的微血管内皮异常，如管腔伪足样突起和内表面缺陷。这些在四名（25%）患者中广泛存在，七名（43.8%）中度存在，五名（31.3%）患者基本不存在。较高程度的 TEM 内皮异常与年龄较小、非特异性间质性肺炎模式、较高的支气管肺泡灌洗淋巴细胞计数、阳性自身抗体以及较低的肺活量、弥散能力和氧合生物标志物相关。我们的结论是，对 ILD 患者的 TBLC 样本进行 TEM 评估是可行的，而观察到的微血管改变值得进一步评估。© 2024。作者。

We evaluated the utility of transmission electron microscopy (TEM) in transbronchial lung cryobiopsy (TBLC) samples from 16 consecutive patients undergoing routine evaluation of fibrotic interstitial lung disease (ILD). Next to routine pathology examination, 1 to 2 TBLC samples were prepared for TEM analysis and evaluated using a Zeiss LEO EM 910. Subpleural cryobiopsies and unfrozen excision biopsies from fresh lobectomy tissue of non-ILD lung cancer patients served as controls. TEM provided high-quality images with only minor cryoartifacts as compared to controls. Furthermore, in several ILD patients we found marked microvascular endothelial abnormalities like luminal pseudopodia-like protrusions and inner surface defects. These were extensively present in four (25%), moderately present in seven (43.8%), and largely absent in five (31.3%) patients. A higher degree of TEM endothelial abnormalities was associated with younger age, non-specific interstitial pneumonia pattern, higher broncho-alveolar lavage lymphocyte count, positive autoantibodies, and lower spirometry, diffusion capacity and oxygenation biomarkers. We conclude that TEM evaluation of TBLC samples from ILD patients is feasible, while the observed microvascular alterations warrant further evaluation.© 2024. The Author(s).