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

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.

Lung Nodule Management: An Interventional Pulmonology Perspective

“…This represents a significant improvement compared to CT-guided lung biopsies. 19 The diagnostic yield, however, is lower for lesions smaller than 2 cm. 20 Chen et al clearly demonstrated an increase in yield with each centimeter increase in size of the peripheral lung lesion.…”

“…26 The diagnostic yield remains inferior to the percutaneous approach. 19 Virtual Bronchoscopy VB is a noninvasive modality designed to assist with navigation to peripheral pulmonary nodules with flexible bronchoscopy. A three-dimensional (3D) reconstruction of the tracheobronchial tree from noncontrast high-resolution CT images of the chest simulates the view a bronchoscopist has during the procedure.…”

An update on the role of bronchoscopy in the diagnosis of pulmonary disease

“…The complication rates were lower (0% to 7.4%) than CT-guided TTNB [ 56 - 58 ]. Pneumothorax occurred in 1.0% of the patients [ 59 ], and bleeding, infection, and breaking of radial probes can occur in some cases [ 58 ].…”

An Open-Source 7-Axis, Robotic Platform to Enable Dexterous Procedures within CT Scanners

“…Other robotic systems [18], [19], [20], [21], [22], including recently released commercial lung biopsy systems [23], [24], offer a bronchoscopic approach via intraluminal steerable needles [25], [26]. However, they have low diagnostic yield in peripheral lungs and for lesions smaller than 20mm [27], [28], [29], [30].…”