Giri Mohan, Huang Guichuan, Puri Anju, Zhuang Rongjuan, Li Yishi, Guo Shuliang
Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China.
Front Med (Lausanne). 2022 Mar 10;9:840702. doi: 10.3389/fmed.2022.840702. eCollection 2022.
Cryobiopsy has emerged as a novel alternative to conventional forceps biopsy for the diagnosis of interstitial lung diseases (ILDs), lung tumors, and peripheral pulmonary lesions (PPLs). This study aims to compare cryobiopsy and forceps biopsy for the diagnosis of these lung pathologies with respect to efficacy and safety by performing a meta-analysis of updated evidence.
A number of databases, such as PubMed, Embase, Web of Science, the Cochrane Library, OVID, CNKI, and Wanfang database, were searched for eligible studies. Randomized and non-randomized comparative studies investigating the efficacy and safety of cryobiopsy vs. forceps biopsy for lung pathologies were included. Pooled results were calculated as an odds ratio () or standardized mean difference (SMD) with 95% .
A total of 39 studies, such as 9 RCTs with 3,586 biopsies (1,759 cryobiopsies and 1,827 flexible forceps biopsies) were analyzed. Cryobiopsy was associated with a significant increase in the diagnostic rates of ILDs (, 4.29; 95% , 1.85-9.93; < 0.01), lung tumors (, 3.58; 95% , 2.60-4.93; < 0.01), and PPLs (, 1.70; 95% , 1.23-2.34; < 0.01). Cryobiopsy yielded significantly larger specimens compared with flexible forceps biopsy (SMD, 3.06; 95% , 2.37-3.74; < 0.01). The cryobiopsy group had a significantly higher (moderate to severe) bleeding risk than the forceps group (, 2.17; 95% , 1.48-3.19; < 0.01). No significant difference was observed in the incidence of pneumothorax between the groups (, 0.90; 95% , 0.44-1.85; = 0.78).
Our results demonstrate that cryobiopsy is a safe and efficacious alternative to conventional forceps biopsy.
冷冻活检已成为诊断间质性肺疾病（ILD）、肺肿瘤及周围性肺病变（PPL）的一种新型替代传统钳夹活检的方法。本研究旨在通过对最新证据进行荟萃分析，比较冷冻活检与钳夹活检在诊断这些肺部疾病方面的有效性和安全性。
检索多个数据库，如PubMed、Embase、Web of Science、Cochrane图书馆、OVID、中国知网（CNKI）和万方数据库，以查找符合条件的研究。纳入调查冷冻活检与钳夹活检对肺部疾病诊断有效性和安全性的随机和非随机对照研究。汇总结果计算为比值比（OR）或标准化均数差（SMD），并给出95%置信区间。
共分析了39项研究，如9项随机对照试验，涉及3586次活检（1759次冷冻活检和1827次可弯曲钳夹活检）。冷冻活检与ILD诊断率显著提高相关（OR，4.29；95%置信区间，1.85 - 9.93；P < 0.01）、肺肿瘤诊断率显著提高相关（OR，3.58；95%置信区间，2.60 - 4.93；P < 0.01）以及PPL诊断率显著提高相关（OR，1.70；95%置信区间，1.23 - 2.34；P < 0.01）。与可弯曲钳夹活检相比，冷冻活检获取的标本显著更大（SMD，3.06；95%置信区间，2.37 - 3.74；P < 0.01）。冷冻活检组（中度至重度）出血风险显著高于钳夹活检组（OR，2.17；95%置信区间，1.48 - 3.19；P < 0.01）。两组气胸发生率未观察到显著差异（OR，0.90；95%置信区间，0.44 - 1.85；P = 0.78）。
我们的结果表明，冷冻活检是传统钳夹活检的一种安全有效的替代方法。
