Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Thorac Cancer. 2023 Jan;14(2):195-205. doi: 10.1111/1759-7714.14733. Epub 2022 Dec 8.
Although radial probe endobronchial ultrasound (R-EBUS) has been used to investigate peripheral pulmonary lesions (PPLs), its diagnostic performance without fluoroscopy remains unclear. We sought to determine the diagnostic yield of R-EBUS-guided transbronchial biopsy (TBB) without fluoroscopy.
We performed a systematic literature review using Pubmed, Embase, and the Cochrane Central Register. Then, we performed a proportional meta-analysis to determine the diagnostic yield of this modality. Subgroup and meta-regression analyses were used to identify factors affecting the performance of R-EBUS-guided TBB without fluoroscopy.
We identified 31 studies consisting of a total of 6491 patients. Pooled overall diagnostic yield of R-EBUS-guided TBB without fluoroscopy was 0.70 (95% confidence interval [CI], 0.67-0.74). There was significant heterogeneity across studies (I = 89.45%, p < 0.001). In subgroup and meta-regression analyses, air bronchus sign on chest computed tomography scans, larger size PPLs, probe location within lesions, and heterogeneous echogenicity were associated with significantly higher diagnostic yield. Diagnostic yield from the upper lobe was statistically lower than that from the middle and lower lobes. Pooled pneumothorax rate was 0.01 (95% CI, 0.01-0.01, I = 63.51%, p < 0.001).
R-EBUS-guided TBB without fluoroscopy appears to be a relatively useful tool with a low pneumothorax rate for the diagnosis of PPLs. Factors mentioned above may affect the diagnostic yield of this tool. Because of substantial between-study heterogeneity, our results should be interpreted with caution.
虽然径向探头支气管内超声（R-EBUS）已用于外周肺部病变（PPL）的检查，但在无透视的情况下其诊断性能尚不清楚。我们旨在确定无透视引导下 R-EBUS 引导经支气管活检（TBB）的诊断效果。
我们使用 Pubmed、Embase 和 Cochrane 中央注册库进行了系统文献回顾。然后，我们进行了比例荟萃分析，以确定该方法的诊断效果。使用亚组和荟萃回归分析来确定影响无透视引导下 R-EBUS 引导 TBB 性能的因素。
我们共纳入 31 项研究，共包含 6491 例患者。无透视引导下 R-EBUS 引导 TBB 的总体诊断效果为 0.70（95%置信区间 [CI]，0.67-0.74）。研究间存在显著异质性（I ² = 89.45%，p < 0.001）。在亚组和荟萃回归分析中，胸部 CT 扫描上的空气支气管征、较大的 PPL 大小、探头在病变内的位置和不均匀的回声强度与更高的诊断效果显著相关。上叶的诊断效果明显低于中、下叶。气胸发生率的汇总率为 0.01（95%CI，0.01-0.01，I ² = 63.51%，p < 0.001）。
无透视引导下 R-EBUS 引导 TBB 似乎是一种相对有用的工具，其气胸发生率低，可用于诊断 PPL。上述因素可能影响该工具的诊断效果。由于研究间存在较大的异质性，我们的结果应谨慎解释。
