Diagnostic Yield and Safety of Image-Guided Pleural Biopsy: A Systematic Review and Meta-Analysis

Abstract

<b><i>Background:</i></b> Diagnostic yield (DY) and safety of computed tomography (CT)- and thoracic ultrasound (TUS)-guided biopsies in the diagnosis of pleural lesions have been investigated in a number of studies, but no synthesis of data from the literature has ever been performed. <b><i>Objectives:</i></b> We aimed to provide the first systematic review and meta-analysis on the DY and safety of CT- versus TUS-guided biopsy in the diagnosis of pleural lesions. <b><i>Method:</i></b> We searched MEDLINE and EMBASE for all studies reporting outcomes of interest published up to April 2018. Two authors reviewed all titles/abstracts and retrieved selected full text to identify studies according to predefined selection criteria. Summary estimates were derived using the random-effects model. Cumulative meta-analysis assessed the influence of increasing adoption of the procedures over time. <b><i>Results:</i></b> Thirty original studies were included in the present review; the number of studies on TUS-guided biopsy was almost three-fold higher than those on CT-guided biopsy. The pooled DYs of the 2 procedures were overall excellent and differed <10%, being 84% for TUS-guided biopsy and 93% for CT-guided biopsy. Safety profiles were reassuring for both the techniques, being 7 and 3% for CT- and TUS-guided biopsy, respectively. DY of ultrasound technique significantly improved over time, while no time effect was observed for CT-guided biopsy. <b><i>Conclusions:</i></b> Data show that CT- and TUS-guided biopsies in the diagnosis of pleural lesions are both excellent procedures, without meaningful differences in DYs and safety. Considering that TUS is non-ionizing and easily performed at the bedside, it should be the preferred approach in presence of adequate skills.

Pleural Involvement in IgG4-Related Disease: Case Report and Review of the Literature

“…However, pleural effusion is commonly faced by clinicians in daily practice, as it may occur in several conditions with different prognoses, as well as treatment options [ 12 ]. Of note, the increasing burden of pleural diseases in the last decades has coupled with an outstanding evolution in medical technologies related to diagnosis and management of such conditions, no longer reserved only to thoracic surgeons or interventional radiologists, but now widely available in interventional pulmonology centers, leading also to the development of a less invasive, but accurate approach, such as TUS-guided percutaneous pleural biopsy [ 13 , 14 ]. Therefore, it is important to increase awareness of this potential cause among physicians from different specialties in order to properly guide the diagnostic work-up, as it is likely that IgG4-RD could account for a proportion of patients with pleural effusions of idiopathic cause [ 15 , 16 , 17 ].…”

“…Furthermore, the response of a majority of the aforementioned diseases to corticosteroid therapy can represent another confounding factor in achieving the correct diagnosis of IgG4-RD. Several techniques to obtain pleural tissue are currently available, including TUS- or CT-guided pleural biopsy, MT, video-assisted thoracoscopic (VATS) and open surgical biopsy [ 13 , 14 ], but in the case of unexplained pleural effusion without significant diffuse thickening, MT is the preferred approach.…”

Surgical Diagnosis of Malignant Pleural Mesothelioma: 20 Years’ Experience at a High-Volume Referral Center

“…Particular caution should be taken in tenuous condition patients, like those presenting with a PS > 2 or a systemic inflammation clinically or at laboratory tests. Nevertheless, the diagnostic efficiency combined with the ability to perform concomitant pleurodesis of surgical procedures offer significant advantage compared to alternative approaches like CT-guided pleural biopsy [ 9 ]. Moreover, reliability and rapidity of the histopathologic specimen obtention is mandatory for appropriate prognosis prediction, treatment assignment, and choice of the strategy of care [ 5 , 10 ].…”

Malignant pleural effusion: Updates in diagnosis, management and current challenges

“…Ultrasound guided biopsies result in similar diagnostic yield (over 90%) however carry significant advantages pertaining to the patient pathway and waiting times. Ultrasound guided biopsies are typically faster to undertake, can be conducted by physicians at the first meeting with the patient without requiring CT scanners, and do not expose patients to ionizing radiation ( 30 ). Ultrasound guided biopsies can be performed by either physicians or radiologists, and can be combined easily with therapeutic drainage procedures such as IPC.…”