Ho An Thi Nhat, Gorthi Ramya, Lee Robert, Chawla Mohit, Patolia Setu
Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 425 E 67th St, New York, NY, 10065, USA.
Department of Pulmonary and Critical Care, St Louis University Hospital, St. Louis, MO, USA.
Lung. 2023 Feb;201(1):85-93. doi: 10.1007/s00408-023-00596-9. Epub 2023 Jan 25.
Transbronchial 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 are still not clear about the diagnostic and safety profile comparison of these two modalities.
We included all randomized controlled trials (RCT) comparing rEBUS-TBB with a flexible bronchoscope and CT-TTB for solitary lung nodules. Two reviewers extracted data independently on diagnostic performance and complication rates.
170 studies were screened, 4 RCT with a 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 diagnostic yield of 75.75% vs 87.7% of CT-TTB. rEBUS-TBB had a significant better safety profile with lower risks 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 and hilum.
CT-TTB had a higher diagnostic yield than rEBUS-TBB in diagnosing peripheral lung nodules, particularly for lesions from 1 to 2 cm. However, rEBUS-TBB was significantly safer with five to eight times less risk of pneumothorax and composite complications of hospital admission, hemorrhage, and pneumothorax. The results of this study only apply to flexible bronchoscopy with radial ebus without navigational technologies. More data are needed for a comparison between CT-TTB with rEBUS-TBB combined with advanced navigational modalities.
经支气管镜肺活检联合径向支气管内超声（rEBUS-TBB）和计算机断层扫描（CT）引导下经胸壁肺活检（CT-TTB）常用于检查周围型肺结节，但关于这两种方法的诊断和安全性比较的高质量数据仍不明确。
我们纳入了所有比较rEBUS-TBB与可弯曲支气管镜及CT-TTB用于孤立性肺结节的随机对照试验（RCT）。两名研究者独立提取有关诊断性能和并发症发生率的数据。
共筛选了170项研究，纳入4项RCT，总计325例患者。CT-TTB的诊断率高于rEBUS-TBB（83.45%对68.82%，风险差异-0.15，95%CI，[-0.24，-0.05]），尤其是对于直径1-2 cm的病变（83%对50%，风险差异-0.33，95%CI，[-0.51，-0.14]）。对于恶性疾病，rEBUS-TBB的诊断率为75.75%，而CT-TTB为87.7%。rEBUS-TBB的安全性显著更好，气胸风险更低（2.87%对21.43%，OR = 0.12，95%CI [百分之五至百分之三十二]）以及住院、出血和气胸的综合发生率更低（8.62%对31.81%，OR 0.21，95%CI，[0.11-0.40]）。增加rEBUS诊断率的因素是病变大小和探头的定位，而非与胸壁和肺门的距离。
在诊断周围型肺结节方面，CT-TTB的诊断率高于rEBUS-TBB，特别是对于1至2 cm的病变。然而，rEBUS-TBB明显更安全，气胸以及住院、出血和气胸综合并发症的风险降低五至八倍。本研究结果仅适用于不带导航技术的径向ebus可弯曲支气管镜检查。需要更多数据来比较CT-TTB与联合先进导航方式的rEBUS-TBB。
