Zhang Zhongbao, Liu Rui, Li JunLin, Zhang Kai, Li Yuan, Zhang Xiaoqin, Rastogi Sanjay
Department of Imaging Medicine, People's Hospital of Inner Mongolia Autonomous Region, Inner Mongolia, Hohho, China.
Boston University Medical Campus, Boston, Massachusetts, United States.
Wideochir Inne Tech Maloinwazyjne. 2024 Jul 31;19(3):299-307. doi: 10.20452/wiitm.2024.17895. eCollection 2024 Oct 16.
Accurate identification of lung lesions during lung biopsy (LB) surgery can be achieved with the use of computed tomography (CT) guidance. The rapid on‑site evaluation (ROSE) method allows for quick assessment of the features, cytomorphological traits, and appropriateness of the obtained tissue samples, and might further accelerate the diagnostic workup.
We aimed to investigate the diagnostic value of CT‑guided aspiration biopsy combined with ROSE for assessment of pulmonary lesions.
A PubMed and Embase search was undertaken until October 2023 to find studies on lung lesion diagnosis utilizing CT‑guided needle biopsy and ROSE. The main method for assessing bias and relevance was the updated Quality Assessment of Diagnostic Accuracy Research 2 tool. The threshold effect and subgroup analysis were used to determine the source or heterogeneity. Sensitivity, specificity, diagnostic odds ratio (DOR), area under the summary receiver operating characteristics curve (SROC AUC), and the Q‑index were calculated. The Deek funnel plot was used to evaluate publication bias.
A total of 6 studies (n = 951) with mild heterogeneity were included in this meta‑analysis, yielding a pooled sensitivity, specificity, and DOR of 0.94 (95% CI, 0.91-0.96), 0.95 (95% CI, 0.9-0.98), and 159.05 (95% CI, 69.59-363.49), respectively. The SROC AUC, calculated using a random‑effects model, was 0.98. Subgroup analysis showed that study design (prospective vs retrospective) had an impact on sensitivity. Further analysis of 3 studies that established control groups showed that the ROSE group had by 12% (95% CI, 0.08-0.16; I = 0) higher sampling adequacy and diagnostic accuracy than the non‑ROSE group, while there was no significant difference in the rate of complications.
For assessment of pulmonary lesions, CT‑guided puncture biopsy combined with ROSE has high sensitivity, specificity, and diagnostic accuracy, and is a practical operational method that merits wide clinical application.
在肺活检（LB）手术中，使用计算机断层扫描（CT）引导能够准确识别肺部病变。快速现场评估（ROSE）方法可对获取的组织样本的特征、细胞形态学特征及适宜性进行快速评估，可能进一步加速诊断工作流程。
我们旨在研究CT引导下穿刺活检联合ROSE对评估肺部病变的诊断价值。
截至2023年10月，在PubMed和Embase数据库进行检索，以查找利用CT引导下针吸活检和ROSE进行肺部病变诊断的研究。评估偏倚和相关性的主要方法是更新后的诊断准确性研究质量评估2工具。采用阈值效应和亚组分析来确定来源或异质性。计算敏感性、特异性、诊断比值比（DOR）、综合受试者操作特征曲线下面积（SROC AUC）和Q指数。使用Deek漏斗图评估发表偏倚。
本荟萃分析共纳入6项研究（n = 951），异质性较小，合并敏感性、特异性和DOR分别为0.94（95%可信区间，0.91 - 0.96）、0.95（95%可信区间，0.9 - 0.98）和159.05（95%可信区间，69.59 - 363.49）。采用随机效应模型计算的SROC AUC为0.98。亚组分析表明，研究设计（前瞻性与回顾性）对敏感性有影响。对3项设立对照组的研究进行进一步分析显示，ROSE组的取材充分性和诊断准确性比非ROSE组高12%（95%可信区间，0.08 - 0.16；I² = 0），而并发症发生率无显著差异。
对于肺部病变的评估，CT引导下穿刺活检联合ROSE具有较高的敏感性、特异性和诊断准确性，是一种值得临床广泛应用的实用操作方法。
