Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule

Abstract

Background: The detection of pulmonary nodules (PNs) is likely to increase, especially with the release of the National Lung Screen Trials. When tissue diagnosis is desired, transthoracic needle aspiration (TTNA) is recommended. Several guided-bronchoscopy technologies have been developed to improve the yield of transbronchial biopsy for PN diagnosis: electromagnetic navigation bronchoscopy (ENB), virtual bronchoscopy (VB), radial endobronchial ultrasound (R-EBUS), ultrathin bronchoscope, and guide sheath. We undertook this meta-analysis to determine the overall diagnostic yield of guided bronchoscopy using one or a combination of the modalities described here.

Methods: We performed a MEDLINE search using “bronchoscopy” and “solitary pulmonary nodule.” Studies evaluating the diagnostic yield of ENB, VB, R-EBUS, ultrathin bronchoscope, and/or guide sheath for peripheral nodules were included. The overall diagnostic yield and yield based on size were extracted. Adverse events, if reported, were recorded. Meta-analysis techniques incorporating inverse variance weighting and a random-effects meta-analysis approach were used.

Results: A total of 3,052 lesions from 39 studies were included. The pooled diagnostic yield was 70%, which is higher than the yield for traditional transbronchial biopsy. The yield increased as the lesion size increased. The pneumothorax rate was 1.5%, which is significantly smaller than that reported for TTNA.

Conclusion: This meta-analysis shows that the diagnostic yield of guided bronchoscopic techniques is better than that of traditional transbronchial biopsy. Although the yield remains lower than that of TTNA, the procedural risk is lower. Guided bronchoscopy may be an alternative or be complementary to TTNA for tissue sampling of PN, but further study is needed to determine its role in the evaluation of peripheral pulmonary lesions.

Figure 1.

A, Chest CT image of a right lower lobe pulmonary lesion in a 78-year-old smoker. B, 3-D reconstruction of the tracheobronchial tree with the nodule outlined. C, Airway reconstruction of the pathway to the peripheral lesion. (Figure created and provided by Broncus Technologies, Inc.) Gen = generation; LMB = left mainstem bronchus; MLB = middle lobe bronchus; RB = right bronchial; RLLB = right lower lobe bronchus; RMB = right mainstem bronchus; RULB = right upper lobe bronchus.

Figure 2.

Literature search and selection. fluoro = fluoroscopy; PN = pulmonary nodule; TTNA = transthoracic needle aspiration.

Figure 3.

Overall summary of the diagnostic yields of the studies included in this meta-analysis.