Abstract
BackgroundAdvances in bronchoscopy and CT-guided lung biopsy have improved the evaluation of small pulmonary lesions (PLs), leading to an increase in preoperative histological diagnosis.We aimed to evaluate the efficacy and safety of transbronchial lung biopsy using radial endobronchial ultrasound and virtual bronchoscopic navigation (TBLB-rEBUS&VBN) and CT-guided transthoracic needle biopsy (CT-TNB) for tissue diagnosis of small PLs.MethodsA systematic search was performed in five electronic databases, including MEDLINE, EMBASE, Cochrane Library Central Register of Controlled Trials, Web of Science, and Scopus, for relevant studies in May 2016; the selected articles were assessed using meta-analysis. The articles were limited to those published after 2000 that studied small PLs ≤ 3 cm in diameter.ResultsFrom 7345 records, 9 articles on the bronchoscopic (BR) approach and 15 articles on the percutaneous (PC) approach were selected. The pooled diagnostic yield was 75% (95% confidence interval [CI], 69–80) using the BR approach and 93% (95% CI, 90–96) using the PC approach. For PLs ≤ 2 cm, the PC approach (pooled diagnostic yield: 92%, 95% CI: 88–95) was superior to the BR approach (66%, 95% CI: 55–76). However, for PLs > 2 cm but ≤ 3 cm, the diagnostic yield using the BR approach was improved to 81% (95% CI, 75–85). Complications of pneumothorax and hemorrhage were rare with the BR approach but common with the PC approach.ConclusionsCT-TNB was superior to TBLB-rEBUS&VBN for the evaluation of small PLs. However, for lesions greater than 2 cm, the BR approach may be considered considering its diagnostic yield of over 80% and the low risk of procedure-related complications.
Highlights
The increasing incidence of lung cancer is a worldwide issue
For pulmonary lesion (PL) 2 cm, the PC approach was superior to the BR approach (66%, 95% confidence interval (CI): 55–76)
transbronchial lung biopsy (TBLB) with radial EBUS and virtual bronchoscopic navigation (VBN) versus computer tomography (CT)-transthoracic needle biopsy (TNB): A meta-analysis extracted for full-text review using the inclusion and exclusion criteria
Summary
The increasing incidence of lung cancer is a worldwide issue. Exposure to tobacco smoke and environmental toxins is the main cause of an increase in the prevalence of lung cancer [1]. Small pulmonary lesions (PLs) may not be discernable in plain chest radiographs; the recent use of low-dose computer tomography (CT) for the screening of lung cancer has improved the PL detection rate [2]. Recent technological advances in bronchoscopy and CT guidance have improved tissue acquisition from small PLs [6,7,8] and reduced the need for invasive procedures, such as surgical lung biopsy, for lesions with radiological ambiguity [3]. Advances in bronchoscopy and CT-guided lung biopsy have improved the evaluation of small pulmonary lesions (PLs), leading to an increase in preoperative histological diagnosis. We aimed to evaluate the efficacy and safety of transbronchial lung biopsy using radial endobronchial ultrasound and virtual bronchoscopic navigation (TBLB-rEBUS&VBN) and CT-guided transthoracic needle biopsy (CT-TNB) for tissue diagnosis of small PLs
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