IMD, PhD. Thoracic Surgeon, Assistant Professor, Thoracic Surgery Division, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
MD, PhD. Thoracic Surgeon, Associate Professor, Thoracic Surgery Division, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
Sao Paulo Med J. 2023 Apr 17;141(5):e2022543. doi: 10.1590/1516-3180.2022.0543.R1.01022023. eCollection 2023.
Imaging tests are important for diagnosis during the management of pulmonary nodules; however, biopsy is required to confirm the malignancy.
To compare the effects of different techniques used for the biopsy of a pulmonary nodule.
Systematic review and meta-analysis were conducted using Cochrane methodology in São Paulo, São Paulo, Brazil.
We conducted a systematic review of randomized controlled trials (RCTs) on minimally invasive techniques, including tomography-guided percutaneous biopsy (PERCUT), transbronchial biopsies with fluoroscopy (FLUOR), endobronchial ultrasound (EBUSR), and electromagnetic navigation (NAVIG). The primary outcomes were diagnostic yield, major adverse events, and need for another approach.
Seven RCTs were included (913 participants; 39.2% female, mean age: 59.28 years). Little to no increase was observed in PERCUT over FLUOR (P = 0.84), PERCUT over EBUSR (P = 0.32), and EBUSR over NAVIG (P = 0.17), whereas a slight increase was observed in NAVIG over FLUOR (P = 0.17); however, the evidence was uncertain. EBUSR may increase the diagnostic yield over FLUOR (P = 0.34). PERCUT showed little to no increase in all bronchoscopic techniques, with uncertain evidence (P = 0.02).
No biopsy method is definitively superior to others. The preferred approach must consider availability, accessibility, and cost, as safety and diagnostic yield do not differ. Further RCTs planned, conducted, and reported with methodological rigor and transparency are needed, and additional studies should assess cost and the correlation between nodule size and location, as well as their association with biopsy results.
PROSPERO database, CRD42018092367 -https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=92367.
影像学检查对于肺结节管理过程中的诊断很重要；然而，活检是确认恶性肿瘤所必需的。
比较用于肺结节活检的不同技术的效果。
在巴西圣保罗的 Cochrane 方法学框架下进行系统评价和荟萃分析。
我们对微创技术（包括 CT 引导经皮活检（PERCUT）、透视引导下经支气管活检（FLUOR）、支气管内超声（EBUSR）和电磁导航（NAVIG））的随机对照试验（RCT）进行了系统评价。主要结局是诊断率、主要不良事件和需要另一种方法。
纳入了 7 项 RCT（913 名参与者；39.2%为女性，平均年龄：59.28 岁）。与 FLUOR 相比，PERCUT 并没有明显增加（P = 0.84），与 EBUSR 相比（P = 0.32）和与 NAVIG 相比（P = 0.17），而与 FLUOR 相比，NAVIG 略有增加（P = 0.17）；然而，证据不确定。与 FLUOR 相比，EBUSR 可能会增加诊断率（P = 0.34）。在所有支气管镜技术中，PERCUT 显示出很少或没有增加，证据不确定（P = 0.02）。
没有一种活检方法绝对优于其他方法。首选方法必须考虑可用性、可及性和成本，因为安全性和诊断率没有差异。需要进一步计划、进行和报告具有方法学严谨性和透明度的 RCT，并应开展额外的研究来评估成本以及结节大小和位置之间的相关性，以及它们与活检结果的关联。
PROSPERO 数据库，CRD42018092367 - https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=92367。
