Comparison between endobronchial ultrasound-guided transbronchial biopsy and CT-guided transthoracic lung biopsy for the diagnosis of peripheral lung cancer: a systematic review and meta-analysis

Abstract

Background: With the release of the National Lung Screening Trial results, the detection of peripheral pulmonary lesions (PPLs) is likely to increase. Computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) and radial probe endobronchial ultrasound (r-EBUS)-guided transbronchial lung biopsy (TBLB) are recommended for tissue diagnosis of PPLs.Methods: A systematic review of published literature evaluating the accuracy of r-EBUS-TBLB and CT-PTNB for the diagnosis of PPLs was performed to determine point sensitivity and specificity, and to construct a summary receiver-operating characteristic curve.Results: This review included 31 publications dealing with EBUS-TBLB and 14 publications dealing with CT-PTNB for the diagnosis of PPLs. EBUS-TBLB had point sensitivity of 0.69 (95% CI: 0.67-0.71) for the diagnosis of peripheral lung cancer (PLC), which was lower than the sensitivity of CT-PTNB (0.94, 95% CI: 0.94-0.95). However, the complication rates observed with EBUS-TBLB were lower than those reported for CT-PTNB.Conclusions: This meta-analysis showed that EBUS-TBLB is a safe and relatively accurate tool in the investigation of PLC. Although the yield remains lower than that of CT-PTNB, the procedural risks are lower.Keywords: Computed tomography-guided percutaneous transthoracic needle biopsy (CT-PTNB); radial probe endobronchial ultrasound-guided transbronchial lung biopsy (r-EBUS-TBLB); peripheral pulmonary lesions; diagnosis; meta-analysis

Diagnostic yield of additional conventional transbronchial lung biopsy following radial endobronchial ultrasound lung biopsy for peripheral pulmonary lesions

“…Previous meta-analyses have shown that the diagnostic accuracy of R-EBUS-GS-guided TBLB ranged from 68.9% to 74.6%, which is comparable to our results (Table S2). [16][17][18][19][20] Although it does not involve navigating the bronchoscope to the target lesion, R-EBUS has been proven to be valuable for confirming the accuracy of biopsy points. 9 After the lesion is localized and the ultrasound probe is removed, R-EBUS-guided TBLB can be performed without losing the position of the nodule by using the GS.…”

“…1 Diagnostic sampling of these small peripheral pulmonary lesions (PPLs) can usually be achieved via a percutaneous needle biopsy (PCNB). However, the incidence of pneumothorax has been reported to be [17][18][19][20][21][22][23][24][25][26].6% in CT-guided PCNB. [2][3][4][5][6] Additionally, PCNB cannot be easily performed for PPLs that are surrounded by emphysema or in patients who cannot hold their breath.…”

Radial endobronchial ultrasonography with distance measurement through a thin bronchoscope for the diagnosis of malignant peripheral pulmonary lesions

“…The medical costs are far lower compared with those of EBUS-GS, the rate of pneumothorax is lower compared with that of CT-guided thoracic biopsy, and the status of the airway can still be clearly determined. Therefore, in the current environment of a relative lack of medical funding in China, EBUS-D-TBB examination with a thin bronchoscope is a relatively good choice for the diagnosis of malignant PPLs in appropriate cases, including lesions size >2 cm, clear bronchus sign on CT scan or CT-guided thoracic biopsy not possible (20). However, the TBB sample size was small, the biopsy margins were limited, and a diagnosis may be missed in cases of mixed disease, which warrants attention.…”

Chinese Expert Consensus Workshop Report: Guideline for permanent iodine‐125 seed implantation of primary and metastatic lung tumors

“…OARS around the tumor should also be delineated. Order iodine‐125 seeds according to the TPS and plan 3D‐PNCT if necessary. An MRI or PET‐CT is recommended to delineate the target volume when atelectasis exists .…”