Department of Radiology, Institute of Medical Science, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea.
Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.
Sci Rep. 2019 Aug 27;9(1):12428. doi: 10.1038/s41598-019-48805-x.
Non-diagnostic results can affect the diagnostic performance of percutaneous transthoracic needle biopsy (PTNB) but have not been critically meta-analyzed yet. To meta-analyze the incidence and malignancy rate of non-diagnostic results, 3-by-2 table approaches rather than the conventional 2-by-2 approaches are needed to know its impact on the diagnostic performance of PTNB. A systematic literature search identified studies evaluating the diagnostic performance of PTNB with extractable outcomes. A total of 143 studies with 35,059 biopsies were included. The pooled incidence of non-diagnostic results was 6.8% (95% CI, 6.0-7.6%; I = 0.91). The pooled malignancy rate of non-diagnostic results was 59.3% (95% CI, 51.7-66.8%; I = 0.80), and was correlated with the prevalence of malignancy (correlation coefficient, 0.66; 95% CI, 0.42-0.91). Pooled percentage decrease of sensitivity and specificity due to non-diagnostic results were 4.5% (95% CI, 3.2-5.7%; I = 0.64) and 10.7% (95% CI, 7.7-13.7%; I = 0.70), respectively, and the pooled incidence of non-diagnostic results was 4.4% (95% CI, 3.2-5.8%; I = 0.83) in lesions ultimately diagnosed as malignancies and 10.4% (95% CI, 7.5-13.8%; I = 0.74) in benign disease. In conclusion, non-diagnostic results averagely occurred in 6.8% of PTNB and more than half of the results were malignancies. The non-diagnostic results decreased specificity and sensitivity by 10.7% and 4.5%, respectively, demanding efforts to minimize the non-diagnostic results in PTNB.
非诊断性结果会影响经皮穿刺肺活检（PTNB）的诊断性能，但尚未对此进行严格的荟萃分析。为了对非诊断性结果的发生率和恶性肿瘤率进行荟萃分析，需要使用 3x2 表方法而不是常规的 2x2 表方法，以了解其对 PTNB 诊断性能的影响。系统文献检索确定了评估 PTNB 可提取结果的诊断性能的研究。共纳入 143 项研究，涉及 35059 例活检。非诊断性结果的总发生率为 6.8%（95%CI，6.0-7.6%；I=0.91）。非诊断性结果的恶性肿瘤率为 59.3%（95%CI，51.7-66.8%；I=0.80），且与恶性肿瘤的患病率相关（相关系数，0.66；95%CI，0.42-0.91）。由于非诊断性结果导致的敏感性和特异性的百分比下降分别为 4.5%（95%CI，3.2-5.7%；I=0.64）和 10.7%（95%CI，7.7-13.7%；I=0.70）。最终诊断为恶性肿瘤的病变中，非诊断性结果的发生率为 4.4%（95%CI，3.2-5.8%；I=0.83），良性疾病中为 10.4%（95%CI，7.5-13.8%；I=0.74）。总之，PTNB 中平均有 6.8%的结果为非诊断性，且超过一半的结果为恶性肿瘤。非诊断性结果使特异性和敏感性分别降低了 10.7%和 4.5%，因此需要努力减少 PTNB 中的非诊断性结果。
