49P Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis

Abstract

Background: Advances in bronchoscopy and computed tomography (CT)-guided lung biopsy have improved the approach to small pulmonary lesions (PLs), leading to an increase in preoperative histological diagnosis. The purpose of this meta-analysis was to evaluate the efficacy and safety issues between transbronchial lung biopsy with radial endobrochial ultrasound and virtual bronchoscopic navigation (TBLB-rEBUS&VBN) as a bronchoscopic (BR) approach and CT-guided transthoracic needle biopsy (CT-TNB) as a percutaneous (PC) approach for the tissue diagnosis of small PLs. Methods: A systematic search for relevant studies was performed in May 2016 using five electronic databases: MEDLINE, EMBASE, Cochrane Library Central Register of Controlled Trials, Web of Science, and Scopus; the selected papers were assessed using meta-analysis. The papers were limited to those published since 2000 that studied small PLs ≤ 3 cm in diameter. To select studies of TBLB-rEBUS&VBN, rEBUS with a GS was used for peripheral pulmonary lesion (PPL) diagnosis and virtual bronchoscopy was used as a navigational method. The three methods of conventional CT-guided transthoracic needle biopsy, CT fluoroscopy-guided transthoracic biopsy, and C-arm cone-beam CT-guided transthoracic biopsy were used for CT-TNB. Results: From 7345 records, 9 papers on the bronchoscopic approach and 15 papers on the percutaneous approach were selected. The pooled diagnostic yield was 75% (95% confidence interval [CI], 69–80) in the BR approach and 93% (95% CI, 90–96) in the PC approach. Especially for tissue biopsy of PLs <2 cm, we recommend prioritizing CT-TNB, which had a 26% better diagnostic yield than TBLB-rEBUS&VBN. However, for PLs >2 cm but ≤3 cm, the yield in the BR approach improved to 81% (95% CI, 75–85). Complications of pneumothorax and hemorrhage were rare in the BR approach and quite common in the PC approach. Conclusions: CT-TNB was superior to TBLB-rEBUS & VBN for the evaluation of small PLs. However, for lesions greater than 2 cm, the BR approach was quite valuable when considering its diagnostic yield of over 80% with its low risk of procedure-related complications. Legal entity responsible for the study: Jung Hyun Chang Funding: Has not received any funding Disclosure: All authors have declared no conflicts of interest.