Meta-analysis of CT-guided transthoracic needle biopsy for the evaluation of the ground-glass opacity pulmonary lesions

Abstract

Objective: This meta-analysis is to determine the overall diagnostic yield of CT-guided transthoracic needle biopsy (TNB) of ground-glass opacity (GGO) lesions. Methods: A PubMed search was performed using "ground-glass opacity" crossed with "core biopsy" and "needle biopsy". Test performance characteristics with the use of forest plots, summary receiver operating characteristic curves and bivariate random effects models were summarized. Adverse events, if reported, were recorded. Results: Our search identified 52 citations, of which 6 diagnostic studies evaluated 341 patients. Pooled specificity estimates were 0.94 [95% confidence interval (CI), 0.84-0.98] and sensitivity estimates were 0.92 (95% CI, 0.88-0.95), respectively. The positive likelihood ratio was 11.27 (95% CI, 4.2-30.6), the negative likelihood ratio was 0.1 (95% CI, 0.06-0.19), the diagnostic odds ratio was 131.38 (95% CI, 39.6-436.0) and the area under the curve was 0.97. Conclusion: Our data suggest that the CT-guided TNB is likely to be a useful tool for tissue diagnosis and may serve as an alternative for further patient management with GGO lesions. However, considering the limited studies and patients included, large scale studies are needed to verify these findings. Advances in knowledge: Some studies about CT-guided TNB of GGO lesions have been published, most have been small, single-institution case series. To our knowledge, our study is the first systematic analysis about CT-guided TNB of GGO lesions.

A Systematic Review and Meta-Analysis of C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Nodules

“…Several previously published systematic reviews or meta-analyses had been conducted with the purpose of obtaining the diagnostic values of conventional fluoroscopy, CT, ultrasonography (US), endoscopic ultrasound (EUS), and endobronchial ultrasound-guided (EBUS) PTNB for the diagnosis of pulmonary lesions [38–41]. Lacasse et al reported that PTNB can be useful for the diagnosis of solitary or localized lesions in the lung [38].…”

“…Gu et al found that EBUS-guided PTNB was a cost-effective, safe and accurate modality for the staging of lung neoplasms,and the sensitivity of EBUS-guided PTNB can be enhanced by selecting patients with lymphadenopathy in CT or PET studies [40]. Yang et al stated that the CT-guided PTNB is a useful tool for the diagnosis and management of ground-glass opacity (GGO) lesions in the lung parenchyma [41]. However, all the four studies mentioned above either focused on the overall accuracy of PTNB or did not calculate the diagnostic accuracy values of CBCT-guided PTNB.…”

Predictive factors for a successful diagnostic bronchoscopy of ground-glass nodules

“…According to the guidelines of the American College of Chest Physicians,[ 5 ] the diagnostic yield of transthoracic needle biopsy for PPLs is at least 90%. Similarly, a recent meta-analysis demonstrated the validity of transthoracic needle biopsy for GGNs as well as solid lesions[ 6 ] although it was associated with a 29.8% risk of pneumothorax. Moreover, transthoracic needle biopsy carries serious risks of hemoptysis, hemothorax, tumor seeding, and air embolism.…”

Managing screening-detected subsolid nodules—the Asian perspective

“…The main reason in support of this practice is a better understanding of the correlation between CT characteristics and histopathological findings (14-16), which has prompted surgical removal of these small GGNs on the basis of radiological diagnosis. Although a high specificity (0.94; 95% CI, 0.84-0.98) and sensitivity (0.92; 95% CI, 0.88-0.95) of percutaneous CT-guided biopsy for GGNs has been reported in meta-analyses (17,18), the diagnostic accuracy of small-sized (<1 cm) GGNs with a lower percentage of ground glass component tended to be lower, which made thoracic surgeons reluctant to perform preoperative biopsy for these small-sized GGNs. Additionally, the risk of complications, such as pneumothorax, hemoptysis and air embolism, is also a reason against biopsy.…”