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 v3

Background Advances in bronchoscopy and CT-guided lung biopsy have improved the approach to small pulmonary lesions (PLs), leading to an increase in preoperative histological diagnosis. We aimed to evaluate the efficacy and safety of transbronchial lung biopsy using radial endobronchial ultrasound, virtual bronchoscopic navigation (TBLB-rEBUS&VBN) and CT-guided transthoracic needle biopsy (CT-TNB). Method A systematic search for relevant studies was performed in May 2016 using five electronic databases: MEDLINE, EMBASE, Cochrane Library Central Register of Controlled Trials, Web of Science, and Scopus; the selected papers were assessed using meta-analysis. The papers were limited to those published since 2000 that studied small pulmonary lesions ≤ 3 cm in diameter. Result From 7345 records, 9 papers on the bronchoscopic (BR) approach and 15 papers on the percutaneous (PC) approach were selected. The pooled diagnostic yield was 75% (95% confidence interval [CI], 69-80) in the BR approach and 93% (95% CI, 90-96) in the PC approach. For PLs ≤ 2 cm, the PC approach was confidently superior to the BR approach. However, for PLs > 2 cm but ≤ 3 cm, the yield in the BR approach improved to 81% (95% CI, 75-85). Complications of pneumothorax and hemorrhage were rare in the BR approach and quite common in the PC approach. Conclusion CT-TNB was superior to TBLB-rEBUS&VBN for the evaluation of small PLs. However, for lesions greater than 2 cm, the BR approach was quite valuable when considering its diagnostic yield of over 80% with its low risk of procedure-related complications.