Zhang Qin, Deng Ming-Ming, Li Xue-Lian, Lu Ye, Hou Gang
National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P.R. China.
Department of Epidemiology, School of Public Health, China Medical University, Shenyang, P.R. China.
Expert Rev Respir Med. 2023 Jul-Dec;17(9):805-813. doi: 10.1080/17476348.2023.2266377. Epub 2023 Oct 27.
Real-time thoracic ultrasound-guided pleural biopsy (TUSPB) is an important diagnostic method for pleural diseases. Traditional two-dimensional thoracic ultrasound, as well as newly developed contrast-enhanced ultrasound (CEUS) and ultrasound elastography (UE), are all used as guidance tools for pleural biopsies. Herein, we aimed to determine the diagnostic yield of real-time TUSPB for pleural diseases to better inform the decision-making process.
A literature search of the MEDLINE/PubMed, Embase, and Cochrane Library databases was performed up to June 2023. A binary random-effects model was applied to determine the pooled diagnostic yield.
Fifteen studies comprising 1553 patients with pleural diseases were included and analyzed. The overall diagnostic yield of TUSPB for pleural diseases was 85.58% (95% confidence interval [CI]: 81.57-89.58%). The sensitivity was 77.56% for pleural malignancy and 80.13% for tuberculous pleurisy. The sub-analysis result revealed that CEUS-guided pleural biopsy provided a pooled diagnostic yield of 98.24%, which was higher than that of conventional TUSPB (78.97%; < 0.01). The overall proportion of adverse events for TUSPB was 6.68% (95% CI: 5.31-8.04%).
Conventional TUSPB has good pooled diagnostic yields and high safety. CEUS and UE are promising guidance tools for pleural biopsy with the potential to increase diagnostic yield.
实时胸部超声引导下胸膜活检（TUSPB）是胸膜疾病的重要诊断方法。传统二维胸部超声以及新开发的对比增强超声（CEUS）和超声弹性成像（UE）均用作胸膜活检的引导工具。在此，我们旨在确定实时TUSPB对胸膜疾病的诊断率，以更好地为决策过程提供信息。
截至2023年6月，对MEDLINE/PubMed、Embase和Cochrane图书馆数据库进行了文献检索。应用二元随机效应模型确定合并诊断率。
纳入并分析了15项研究，共1553例胸膜疾病患者。TUSPB对胸膜疾病的总体诊断率为85.58%（95%置信区间[CI]：81.57 - 89.58%）。对胸膜恶性肿瘤的敏感性为77.56%，对结核性胸膜炎的敏感性为80.13%。亚分析结果显示，CEUS引导下胸膜活检的合并诊断率为98.24%，高于传统TUSPB（78.97%；P < 0.01）。TUSPB不良事件的总体发生率为6.68%（95% CI：5.31 - 8.04%）。
传统TUSPB具有良好的合并诊断率和高安全性。CEUS和UE是有前景的胸膜活检引导工具，有可能提高诊断率。
