Department of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA.
Division of Pulmonary and Critical Care, Cedars Sinai Medical Center, Los Angeles, CA.
J Bronchology Interv Pulmonol. 2024 Jan 1;31(1):70-81. doi: 10.1097/LBR.0000000000000942.
Robotic-assisted navigation bronchoscopy (RANB) is a novel method to biopsy lung nodules, with initial reports demonstrating excellent accuracy. We aimed to evaluate pooled estimates of diagnostic yields and complication rates with RANB by performing a meta-analysis of the available literature.
We searched 3 databases, including PubMed, EmBase, and Web of Science. The resulting abstracts were reviewed by 2 investigators. Analyses were performed using random effects models, and diagnostic yield and complication rates were estimated after the Freeman-Tukey transformation.
A total of 23 articles, comprising 1409 patients and 1541 nodules, were included in the final analysis. Mean ages ranged from 63.2 to 69.3 years. The average size of the nodules ranged between 5.9 and 25.0 mm. Most patients (54.0% to 92.0%) had a current or prior smoking history in studies that reported them (n=8). The pooled diagnostic yield was 81.9% (12 studies, 838 nodules, 95% CI: 83.4%-91.0%), and the pooled sensitivity for malignancy was 87.6% (8 studies, 699 nodules, 95% CI: 81.3%-89.5%). The pooled incidence of pneumothorax rates was 0.60% (95% CI: 0.11%-1.35%). The pooled incidence of major bleeding was <0.01%.
Diagnostic yield for patients with pulmonary nodules undergoing RANB is high, though may be impacted by the prevalence of malignancy, participant selection, and publication bias. Complication rates, including pneumothoraces and bleeding rates, appear low across all studies. If RANB is available, clinicians should consider utilizing this platform to biopsy pulmonary nodules.
机器人辅助导航支气管镜（RANB）是一种新的肺结节活检方法，初步报告显示其具有很高的准确性。我们旨在通过对现有文献进行荟萃分析来评估 RANB 的诊断收益和并发症发生率的汇总估计。
我们搜索了 3 个数据库，包括 PubMed、EmBase 和 Web of Science。由 2 名研究人员对检索到的摘要进行了评估。使用随机效应模型进行分析，并在 Freeman-Tukey 变换后估计诊断收益和并发症发生率。
共有 23 篇文章，包括 1409 名患者和 1541 个结节，被纳入最终分析。平均年龄范围为 63.2 至 69.3 岁。结节的平均大小在 5.9 至 25.0mm 之间。在报告这些信息的研究中，大多数患者（54.0%至 92.0%）有当前或既往吸烟史（n=8）。汇总的诊断收益为 81.9%（12 项研究，838 个结节，95%置信区间：83.4%-91.0%），恶性肿瘤的汇总敏感性为 87.6%（8 项研究，699 个结节，95%置信区间：81.3%-89.5%）。气胸的汇总发生率为 0.60%（95%置信区间：0.11%-1.35%）。主要出血的汇总发生率<0.01%。
接受 RANB 治疗的肺结节患者的诊断收益较高，但可能受到恶性肿瘤的患病率、参与者选择和发表偏倚的影响。所有研究的并发症发生率，包括气胸和出血发生率均较低。如果 RANB 可用，临床医生应考虑利用该平台对肺结节进行活检。
