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胸膜冷冻活检与钳取活检用于评估未确诊胸腔积液的疗效和安全性:一项系统评价与Meta分析

Efficacy and Safety of Pleural Cryobiopsy vs. Forceps Biopsy for Evaluation of Undiagnosed Pleural Effusion: A Systematic Review and Meta-Analysis.

作者信息

Giri Mohan, Dai Haiyun, Guo Shuliang, Li Yishi, He Lin, Zhuang Rongjuan

机构信息

Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Department of Respiratory and Critical Care Medicine, Fuling Central Hospital, Chongqing, China.

出版信息

Front Med (Lausanne). 2022 Apr 11;9:847146. doi: 10.3389/fmed.2022.847146. eCollection 2022.

Abstract

BACKGROUND

Pleural cryobiopsy is a novel technique for the diagnosis of pleural pathologies. However, the safety and feasibility of this modality compared to standard forceps for pleural biopsy has not been fully elucidated. This systematic review and meta-analysis aims to establish the efficacy and safety of cryobiopsy for evaluation of undiagnosed pleural effusion.

METHODS

For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and Web of science databases up to December 16, 2021 to identify relevant articles. We included randomized controlled trials, cohort studies, retrospectives studies and case series that compared pleural cryobiopsy and forceps biopsy. A qualitative assessment was performed using the QUADAS-2 tool.

RESULTS

Of the 365 articles identified by our search, 15 studies were eligible for inclusion. The specimen sizes obtained with cryobiopsy were significantly larger compared with forceps biopsy (Standard mean difference 1.16; 95 % CI: 0.51-1.82; < 0.01). Furthermore, the cryobiopsy tissue specimens were deeper (OR 2.68; 95 % CI: 1.39-5.16; < 0.01) and qualitatively better with less crush artifacts (OR 0.06; 95 % CI: 0.01-0.26; < 0.01). There was no significant difference in diagnostic yield (OR 1.32; 95 % CI: 0.79-2.21; = 0.29) and mild to moderate bleeding events (OR 1.21; 95 % CI: 0.64-2.29; = 0.57) between pleural cryobiopsy and forceps biopsy. No publication bias was observed among these studies.

CONCLUSIONS

Compared to flexible forceps biopsy pleural cryobiopsy obtained larger and deeper tissue specimens with less crush artifacts but does not show superiority for diagnostic yield. Further studies are still needed to verify these findings.

摘要

背景

胸膜冷冻活检是一种用于诊断胸膜病变的新技术。然而,与标准胸膜活检钳相比,这种方法的安全性和可行性尚未完全阐明。本系统评价和荟萃分析旨在确定冷冻活检在评估不明原因胸腔积液方面的有效性和安全性。

方法

对于本系统评价和荟萃分析,我们检索了截至2021年12月16日的PubMed、Embase、Scopus和Web of science数据库,以识别相关文章。我们纳入了比较胸膜冷冻活检和活检钳活检的随机对照试验、队列研究、回顾性研究和病例系列。使用QUADAS-2工具进行定性评估。

结果

在我们检索到的365篇文章中,有15项研究符合纳入标准。与活检钳活检相比,冷冻活检获得的标本尺寸明显更大(标准均差1.16;95%可信区间:0.51-1.82;P<0.01)。此外,冷冻活检组织标本更深(比值比2.68;95%可信区间:1.39-5.16;P<0.01),质量更好,挤压伪像更少(比值比0.06;95%可信区间:0.01-0.26;P<0.01)。胸膜冷冻活检和活检钳活检在诊断率(比值比1.32;95%可信区间:0.79-2.21;P=0.29)和轻度至中度出血事件(比值比1.21;95%可信区间:0.64-2.29;P=0.57)方面没有显著差异。这些研究中未观察到发表偏倚。

结论

与柔性活检钳活检相比,胸膜冷冻活检获得的组织标本更大、更深,挤压伪像更少,但在诊断率方面没有显示出优势。仍需进一步研究来验证这些发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac8/9035697/83e79a10ce50/fmed-09-847146-g0001.jpg

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