Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China,
Institute of Medical Technology, Peking University Health Science Center, Beijing, China,
Respiration. 2024;103(11):661-674. doi: 10.1159/000539876. Epub 2024 Jul 29.
Previous meta-analyses have explored the diagnostic accuracy and safety of computed tomography-guided percutaneous lung biopsy of ground-glass opacities (GGOs). However, no research investigated the role of nonsurgical biopsies (including transbronchial approaches). Additionally, studies reporting the diagnostic accuracy of GGOs with different characteristics are scarce, with no quantitative assessment published to date. We performed a systematic review to explore the diagnostic accuracy and safety of nonsurgical biopsy for diagnosing GGOs, especially those with higher ground-glass components and smaller nodule sizes.
A thorough literature search of four databases was performed to compile studies evaluating both or either of the diagnostic accuracy and complications of nonsurgical biopsy for GGOs. A bivariate random-effects model and random-effect model were utilized for data synthesis. The methodological quality of the studies was assessed according to the Quality Assessment of Diagnostic Accuracy Studies-2 tool.
Nineteen eligible studies with a total of 1,379 biopsy-sampled lesions were analyzed, of which 1,124 were confirmed to be malignant. Nonsurgical biopsy reported a pooled sensitivity of 0.89, a specificity of 0.99, and a negative predictive value (NPV) of 60.3%. The overall sensitivity, specificity, and NPV of nonsurgical biopsy for diagnosing GGOs according to GGO component were 0.90, 0.99, and 77.2% in pure GGOs; 0.87, 0.99, and 67.2% in GG-predominant lesions; and 0.89, 1.00, and 44.1% in solid-predominant lesions, respectively. Additionally, the diagnostic sensitivity was better in lesions ≥20 mm than in small lesions (0.95 vs. 0.88). Factors that contributed to higher sensitivity were the use of a coaxial needle system and CT fluoroscopy but not the needle gauge. The summary sensitivity of core needle biopsy (CNB) was not significantly higher than fine needle aspiration (FNA) (0.92 vs. 0.84; p = 0.42); however, we found an increased incidence of hemorrhage in CNB compared with FNA (60.9 vs. 14.2%; p = 0.012).
Nonsurgical biopsy for diagnosing GGOs shows high sensitivity and specificity with an acceptably low risk of complications. However, negative biopsy results are unreliable in excluding malignancy, necessitating resampling or subsequent follow-up. The applicability of our study is limited due to significant heterogeneity, indirect comparisons, and the paucity of data on bronchoscopic approaches, restricting the generalizability of our findings to patients requiring transbronchial biopsies.
先前的荟萃分析探讨了计算机断层扫描引导下经皮肺活检磨玻璃密度结节（GGOs）的诊断准确性和安全性。然而，尚无研究调查非手术活检（包括经支气管途径）的作用。此外，报告具有不同特征的 GGOs 诊断准确性的研究很少，迄今为止尚未发表定量评估。我们进行了系统评价，以探讨非手术活检诊断 GGOs，特别是具有较高磨玻璃成分和较小结节大小的 GGOs 的诊断准确性和安全性。
对四个数据库进行了全面的文献检索，以汇编评估非手术活检对 GGOs 的诊断准确性和并发症的研究。使用双变量随机效应模型和随机效应模型进行数据综合。根据诊断准确性研究的质量评估-2 工具评估研究的方法学质量。
分析了 19 项符合条件的研究，共分析了 1379 个活检采样病变，其中 1124 个被证实为恶性。非手术活检的总体敏感性为 0.89，特异性为 0.99，阴性预测值（NPV）为 60.3%。根据 GGO 成分，非手术活检诊断 GGOs 的总体敏感性、特异性和 NPV 分别为纯 GGO 为 0.90、0.99 和 77.2%；GG 为主病变为 0.87、0.99 和 67.2%；以实性为主的病变为 0.89、1.00 和 44.1%。此外，≥20mm 病变的诊断敏感性优于小病变（0.95 比 0.88）。有助于提高敏感性的因素是使用同轴针系统和 CT 透视，但不是针规。芯针活检（CNB）的汇总敏感性并不明显高于细针抽吸（FNA）（0.92 比 0.84；p=0.42）；然而，我们发现 CNB 比 FNA 的出血发生率更高（60.9%比 14.2%；p=0.012）。
非手术活检诊断 GGOs 具有较高的敏感性和特异性，并发症风险可接受。然而，阴性活检结果不能可靠地排除恶性肿瘤，需要重新取样或随后进行随访。由于存在显著的异质性、间接比较以及支气管镜方法的数据缺乏，我们的研究适用性有限，限制了我们的发现对需要经支气管活检的患者的普遍性。
