Solitary Lung Nodule: CT-Guided Transthoracic Biopsy vs Transbronchial Biopsy With Endobronchial Ultrasound and Flexible Bronchoscope, a Meta-Analysis of Randomized Controlled Trials

Abstract

BackgroundTransbronchial lung biopsy with radial endobronchial ultrasound (rEBUS-TBB) and Computed tomography (CT) scan guided transthoracic biopsy (CT-TTB) are commonly used to investigate peripheral lung nodules but high quality data is still not clear about the diagnostic and safety pro le comparison of these two modalities. MethodWe included all randomized controlled trials (RCT) comparing rEBUS-TBB with a exible bronchoscope and CT-TTB for solitary lung nodules. Two reviewers extracted data independently on diagnostic performance and complication rates.Results 170 studies were screened, 4 RCT with total of 325 patients were included. CT-TTB had a higher diagnostic yield than rEBUS-TBB (83.45% vs 68.82%, risk difference − 0.15, 95% CI, [-0.24,-0.05]), especially for lesion size 1-2 cm (83% vs 50%, risk difference − 0.33, 95% CI, [-0.51,-0.14]). For malignant diseases, rEBUS-TBB had a combined diagnostic yield of 75.75% vs 87.7% of CT-TTB. rEBUS-TBB had a signi cant better safety pro le with lower risk of pneumothorax (2.87% vs 21.43%, OR = 0.12, 95% CI [0.05-0.32]) and combined outcomes of hospital admission, hemorrhage and pneumothorax (8.62% vs 31.81%, OR 0.21, 95% CI, [0.11-0.40]). Factors increasing diagnostic yield of rEBUS were lesion size and localization of the probe but not the distance to the chest wall, hilum nor probe localizing adjacent to the lesion. ConclusionCT-TTB has a higher diagnostic yield than rEBUS-TBB in diagnosing peripheral lung nodules, particularly for lesions from 1 cm to 2 cm. However, rEBUS-TBB is signi cantly safer with ve to eight times less risk of pneumothorax and composite complications of hospital admission, hemorrhage and pneumothorax.

Application of uniportal video-assisted thoracoscopic surgery for segmentectomy in early-stage non-small cell lung cancer: A narrative review

“…Its effectiveness is further enhanced by advanced technologies, such as ultrasound bronchoscopy and virtual electromagnetic navigation, offering reduced trauma and heightened precision. However, this method involves specific patient selection criteria and faces challenges in achieving spatial precision [ 30 , 31 ]. Indocyanine green fluorescence staining: The use of indocyanine green (ICG) fluorescence staining in pulmonary segmentectomy represents a significant technological advancement.…”

“…Its effectiveness is further enhanced by advanced technologies, such as ultrasound bronchoscopy and virtual electromagnetic navigation, offering reduced trauma and heightened precision. However, this method involves specific patient selection criteria and faces challenges in achieving spatial precision [ 30 , 31 ].…”

The incremental contribution of mobile cone-beam computed tomography to the tool–lesion relationship during shape-sensing robotic-assisted bronchoscopy

“…Rates of detection and sampling of pulmonary lesions has increased significantly over the past two decades, primarily due to widespread use of computed tomography (CT) and implementation of lung cancer screening guidelines [1]. Within the context of lung cancer, society guidelines recommend bronchoscopy for tissue acquisition since it allows for concomitant mediastinal lymph node staging [2]; however, the diagnostic yield of legacy guided bronchoscopy platforms has been relatively low at a range of 65-73% [3][4][5][6]. While the safety profile of guided bronchoscopy in terms of pneumothorax and bleeding is superb, its diagnostic yield rate remains inferior compared to the alternative approach of transthoracic image-guided sampling [6][7][8][9][10].…”

Advanced Bronchoscopic Diagnostic Techniques in Lung Cancer

“…odds ratio [OR], 0.12; 95% CI, 0.05 to 0.32) and combined outcomes of hospital admission, hemorrhage, and pneumothorax (8.62% vs. 31.81%; OR, 0.21; 95% CI, 0.11 to 0.40) 8 .…”