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Solitary Lung Nodule: CT-Guided Transthoracic Biopsy vs Transbronchial Biopsy With Endobronchial Ultrasound and Flexible Bronchoscope, a Meta-Analysis of Randomized Controlled Trials

  • INTERVENTIONAL PULMONOLOGY
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Abstract

Background

Transbronchial lung biopsy with radial endobronchial ultrasound (rEBUS-TBB) and Computed tomography (CT) scan-guided transthoracic biopsy (CT-TTB) are commonly used to investigate peripheral lung nodules but high-quality data are still not clear about the diagnostic and safety profile comparison of these two modalities.

Method

We included all randomized controlled trials (RCT) comparing rEBUS-TBB with a flexible bronchoscope and CT-TTB for solitary lung nodules. Two reviewers extracted data independently on diagnostic performance and complication rates.

Results

170 studies were screened, 4 RCT with a total of 325 patients were included. CT-TTB had a higher diagnostic yield than rEBUS-TBB (83.45% vs 68.82%, risk difference − 0.15, 95% CI, [− 0.24, − 0.05]), especially for lesion size 1–2 cm (83% vs 50%, risk difference − 0.33, 95% CI, [− 0.51, − 0.14]). For malignant diseases, rEBUS-TBB had a diagnostic yield of 75.75% vs 87.7% of CT-TTB. rEBUS-TBB had a significant better safety profile with lower risks of pneumothorax (2.87% vs 21.43%, OR = 0.12, 95% CI [0.05–0.32]) and combined outcomes of hospital admission, hemorrhage, and pneumothorax (8.62% vs 31.81%, OR 0.21, 95% CI, [0.11–0.40]). Factors increasing diagnostic yield of rEBUS were lesion size and localization of the probe but not the distance to the chest wall and hilum.

Conclusion

CT-TTB had a higher diagnostic yield than rEBUS-TBB in diagnosing peripheral lung nodules, particularly for lesions from 1 to 2 cm. However, rEBUS-TBB was significantly safer with five to eight times less risk of pneumothorax and composite complications of hospital admission, hemorrhage, and pneumothorax. The results of this study only apply to flexible bronchoscopy with radial ebus without navigational technologies. More data are needed for a comparison between CT-TTB with rEBUS-TBB combined with advanced navigational modalities.

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References

  1. Rahib L, Wehner MR, Matrisian LM, Nead KT (2021) Estimated projection of US cancer incidence and death to 2040. JAMA Netw Open 4(4):e214708–e214708

    Article  PubMed  PubMed Central  Google Scholar 

  2. T. National Lung Screening Trial Research, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365(5):395–409

    Article  Google Scholar 

  3. Ost D, Fein AM, Feinsilver SH (2003) Clinical practice The solitary pulmonary nodule. N Engl J Med 348(25):2535–2542

    Article  PubMed  Google Scholar 

  4. MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR, Mehta AC, Ohno Y, Powell CA, Prokop M, Rubin GD, Schaefer-Prokop CM, Travis WD, Schil PEV, Bankier AA (2017) Guidelines for management of incidental pulmonary nodules detected on CT images: from the fleischner society 2017. Radiology 284(1):228–243

    Article  PubMed  Google Scholar 

  5. Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, Pointon K, Richardson C, Sawicka E (2003) Guidelines for radiologically guided lung biopsy. Thorax 58(11):920–36

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M (2017) Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol 27(1):138–148

    Article  CAS  PubMed  Google Scholar 

  7. Yang W, Sun W, Li Q, Yao Y, Lv T, Zeng J, Liang W, Zhou X, Song Y (2015) Diagnostic accuracy of CT-guided transthoracic needle biopsy for solitary pulmonary nodules. PLoS ONE 10(6):e0131373

    Article  PubMed  PubMed Central  Google Scholar 

  8. Han Y, Kim HJ, Kong KA, Kim SJ, Lee SH, Ryu YJ, Lee JH, Kim Y, Shim SS, Chang JH (2018) Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: a systematic review and meta-analysis. PLoS ONE 13(1):e0191590

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gupta A, Suri JC, Bhattacharya D, Sen MK, Chakrabarti S, Singh A, Adhikari T (2018) Comparison of diagnostic yield and safety profile of radial endobronchial ultrasound-guided bronchoscopic lung biopsy with computed tomography-guided percutaneous needle biopsy in evaluation of peripheral pulmonary lesions: a randomized controlled trial. Lung India 35(1):9–15

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wang W, Yu L, Wang Y, Zhang Q, Chi C, Zhan P, Xu C (2018) Radial EBUS versus CT-guided needle biopsy for evaluation of solitary pulmonary nodules. Oncotarget 9(19):15122–15131

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fielding DI, Chia C, Nguyen P, Bashirzadeh F, Hundloe J, Brown IG, Steinke K (2012) Prospective randomised trial of endobronchial ultrasound-guide sheath versus computed tomography-guided percutaneous core biopsies for peripheral lung lesions. Intern Med J 42(8):894–900

    Article  CAS  PubMed  Google Scholar 

  12. Steinfort DP, Vincent J, Heinze S, Antippa P, Irving LB (2011) Comparative effectiveness of radial probe endobronchial ultrasound versus CT-guided needle biopsy for evaluation of peripheral pulmonary lesions: a randomized pragmatic trial. Respir Med 105(11):1704–1711

    Article  PubMed  Google Scholar 

  13. Folch EE, Pritchett MA, Nead MA, Bowling MR, Murgu SD, Krimsky WS, Murillo BA, LeMense GP, Minnich DJ, Bansal S, Ellis BQ, Mahajan AK, Gildea TR, Bechara RI, Sztejman E, Flandes J, Rickman OB, Benzaquen S, Hogarth DK, Linden PA, Wahidi MM, Mattingley JS, Hood KL, Lin H, Wolvers JJ, Khandhar SJ, Investigators NS (2019) Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: one-year results of the prospective multicenter NAVIGATE Study. J Thorac Oncol 14(3):445–458

    Article  PubMed  Google Scholar 

  14. Kalchiem-Dekel O, Connolly JG, Lin IH, Husta BC, Adusumilli PS, Beattie JA, Buonocore DJ, Dycoco J, Fuentes P, Jones DR, Lee RP, Park BJ, Rocco G, Chawla M, Bott MJ (2022) Shape-sensing robotic-assisted bronchoscopy in the diagnosis of pulmonary parenchymal lesions. Chest 161(2):572–582

    Article  PubMed  Google Scholar 

  15. Agrawal A, Hogarth DK, Murgu S (2020) Robotic bronchoscopy for pulmonary lesions: a review of existing technologies and clinical data. J Thorac Dis 12(6):3279–3286

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gex G, Pralong JA, Combescure C, Seijo L, Rochat T, Soccal PM (2014) Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: a systematic review and meta-analysis. Respiration 87(2):165–176

    Article  PubMed  Google Scholar 

  17. Oki M, Saka H, Ando M, Asano F, Kurimoto N, Morita K, Kitagawa C, Kogure Y, Miyazawa T (2015) Ultrathin bronchoscopy with multimodal devices for peripheral pulmonary lesions. A randomized trial. Am J Respir Crit Care Med 192(4):468–476

    Article  PubMed  Google Scholar 

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Funding

There is no funding for this study.

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Authors and Affiliations

  1. Department of Pulmonary and Critical Care, St Louis University Hospital, St. Louis, MO, USA

    Ramya Gorthi & Setu Patolia

  2. Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 425 E 67th St, New York, NY, 10065, USA

    An Thi Nhat Ho, Robert Lee & Mohit Chawla

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  1. An Thi Nhat Ho
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  2. Ramya Gorthi
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Contributions

Conception and design: A.T.N.H and S.P. Administrative support: S.P, R.L, and M.C. Provision of study materials or patients: not applicable. Collection and assembly of data: A.T.N.H, R.G, and S.P. Data analysis and interpretation: A.T.N.H and S.P. Manuscript writing: all authors. Final approval of manuscript: all authors.

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Correspondence to An Thi Nhat Ho.

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Ho, A.T.N., Gorthi, R., Lee, R. et al. Solitary Lung Nodule: CT-Guided Transthoracic Biopsy vs Transbronchial Biopsy With Endobronchial Ultrasound and Flexible Bronchoscope, a Meta-Analysis of Randomized Controlled Trials. Lung 201, 85–93 (2023). https://doi.org/10.1007/s00408-023-00596-9

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