Efficacy and safety of cone-beam computed tomography-guided bronchoscopy for peripheral pulmonary lesions: a systematic review and meta-analysis.

IF 1.9 3区医学 Q3 RESPIRATORY SYSTEM Journal of thoracic disease Pub Date : 2025-02-28 Epub Date: 2025-02-18 DOI:10.21037/jtd-24-1224

Ziling Li, Shuyun Xu, Yong Zhang, Jing Shi

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Abstract

Background: Cone-beam computed tomography (CBCT)-guided bronchoscopy is increasingly utilized for diagnosing peripheral pulmonary lesions (PPLs). We carried out the meta-analysis for assessing the efficacy and safety of CBCT-guided bronchoscopy for PPLs.

Methods: An extensive search in several databases was conducted to identify relevant articles. We evaluated the quality of studies with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The pooled diagnostic yield (DY) and adverse event rate with the 95% confidence interval (CI) were computed. Subgroup analyses were performed according to additional use of navigation, use of radial endobronchial ultrasound (rEBUS), use of fixed or mobile CBCT, whether computed tomography (CT) spin was performed before biopsy to affirm tool-in-lesion, use of rapid onsite cytologic examination (ROSE), strictness of the definition of DY, and study design. Further analysis was performed to explore the association between odds of diagnosis with CBCT guided bronchoscopy and PPLs characteristics (>20 vs. ≤20 mm, non-upper lobe vs. upper lobe, with bronchus sign vs. without bronchus sign, and solid vs. non-solid) as well as sampling methods (forceps vs. fine needle aspiration, forceps vs. cryoprobe sampling). The pooled odds ratio (OR) and 95% CI were calculated. The significance level was set at 0.05. All analyses were performed by using meta package in R version 4.3.2.

Results: We included 23 studies involving 1,769 patients and 1,863 PPLs in the meta-analysis. The overall pooled DY of CBCT-guided bronchoscopy was 80.2% (95% CI: 76.0-84.1%). Subgroup analysis showed that the DY was highest when CBCT was used with robotic-assisted navigation bronchoscopy (pooled DY 87.5%; 95% CI: 81.5-92.4%), the DY was 78.9% (95% CI: 70.8-85.9%) when CBCT was used alone without other navigation techniques. Lesion size >20 mm, presence of bronchus sign and solid lesions were associated with significant increase in the odds of diagnosis with CBCT-guided bronchoscopy. Pooled adverse event rate was 2.3% (95% CI: 1.2-3.6%).

Conclusions: CBCT-guided bronchoscopy is a safe technique with high DY in diagnosing PPLs.

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锥形束计算机断层扫描引导支气管镜检查周围肺病变的有效性和安全性：系统回顾和荟萃分析。

背景：锥形束计算机断层扫描（CBCT）引导下的支气管镜检查越来越多地用于诊断周围性肺病变（ppl）。我们进行了荟萃分析，以评估cbct引导支气管镜治疗ppl的有效性和安全性。方法：在多个数据库中进行广泛检索，以确定相关文章。我们使用诊断准确性研究质量评估（QUADAS-2）工具评估研究的质量。计算合并诊断率（DY）和不良事件发生率（95%置信区间CI）。亚组分析根据额外的导航使用、径向支气管超声（rEBUS）使用、固定或移动CBCT使用、活检前是否进行计算机断层扫描（CT）旋转以确认病变内工具、使用快速现场细胞学检查（ROSE）、DY定义的严格性和研究设计进行。进一步分析了CBCT引导下支气管镜诊断的几率与pps特征（bbb20 vs≤20 mm，非上肺叶vs上肺叶，有支气管征象vs无支气管征象，实性与非实性）以及取样方法（镊子vs细针穿刺，镊子vs冷冻探针取样）之间的关系。计算合并优势比（OR）和95% CI。显著性水平设为0.05。所有分析均使用R 4.3.2版本的meta包进行。结果：我们在meta分析中纳入了23项研究，涉及1769名患者和1863名ppl。cbct引导支气管镜检查的总合并DY为80.2% （95% CI: 76.0-84.1%）。亚组分析显示，CBCT与机器人辅助导航支气管镜联合使用时，DY最高(合计DY 87.5%；95% CI: 81.5-92.4%)，单独使用CBCT时，DY为78.9% （95% CI: 70.8-85.9%）。病变大小为bbb20 mm，支气管征象和实性病变的存在与cbct引导下支气管镜诊断率显著增加相关。合并不良事件发生率为2.3% （95% CI: 1.2-3.6%）。结论：cbct引导下支气管镜检查是一种安全的诊断ppl的技术。

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来源期刊

Journal of thoracic disease RESPIRATORY SYSTEM-

CiteScore

4.60

自引率

4.00%

发文量

254

期刊介绍： The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.