Endobronchial ultrasound-guided versus computed tomography-guided biopsy for peripheral pulmonary lesions: A meta-analysis.

Abstract

Both endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) and computed tomography-guided transthoracic needle biopsy (CT-TTNB) are approaches commonly utilized to diagnose peripheral pulmonary lesions (PPLs). The present meta-analysis was, therefore, designed to provide more reliable evidence regarding the relative advantages of these two approaches to PPL diagnosis in order to guide clinical decision making. The PubMed, Embase, and Cochrane Library databases were searched for relevant studies published as of May 2020. Endpoint data pertaining to technical success rates, diagnostic accuracy, and complication rates were then extracted from these studies. Meta-analyses were conducted using RevMan v5.3. We identified nine total relevant studies for inclusion in the present meta-analysis, incorporating 2025 total patients (2035 total procedures) that underwent EBUS-TBB (n=994) or CT-TTNB (n=1041) for the purposes of PPL diagnosis. Rates of technical success were comparable between these two groups (odds ratio [OR]: 0.16; P=0.21). However, CT-TTNB was associated with higher diagnostic yield (OR: 0.23; P<0.00001), greater accuracy (OR: 0.43; P=0.002), and higher rates of complications (OR: 7.27; P<0.00001) than was EBUS-TBB. Subgroup analyses revealed that CT-TTNB was associated with better diagnostic yield and accuracy when analyzing small lesions and lesions that were proximal to the pleura. Significant heterogeneity among studies was detected with respect to both technical success rates and diagnostic yield, but there was no evidence of publication bias. When diagnosing PPLs, CT-TTNB is associated with higher diagnostic yield and accuracy but with poorer safety outcomes than EBUS-TBB.