Chest
Volume 142, Issue 2, August 2012, Pages 385-393
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Original Research
Pulmonary Procedures
Meta-analysis of Guided Bronchoscopy for the Evaluation of the Pulmonary Nodule

https://doi.org/10.1378/chest.11-1764Get rights and content

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.

Section snippets

Data Sources

An Ovid MEDLINE (1950 through October 2010) and PubMed database search was performed using “bronchoscopy” and “pulmonary nodule” as terms to identify studies. The search was limited to human subjects. Although the search was not limited to English language studies, no non-English language studies met the inclusion criteria. The reference lists of included studies and review articles were searched manually for other relevant studies.

Study Selection

Review articles and commentaries were excluded from the

Results

The MEDLINE and PubMed searches identified 140 and 309 potential studies, respectively. A thorough review of the reference lists of related studies uncovered an additional 29 studies. From these, a total of 39 studies met the inclusion criteria and were included in the analysis (Fig 2). The included studies were published between 2002 and October 2010. All studies reported the diagnostic yield of bronchoscopic biopsy of PN using at least one of five guidance techniques: VB, ENB, R-EBUS, guide

Discussion

This study has several important findings that may influence our current practice and approach to the evaluation and management of PN. First, the pooled diagnostic yield of 70% is much higher than yields reported previously using traditional bronchoscopic techniques.5, 6 Second, although the diagnostic yield for guided bronchoscopic techniques is lower than that reported for TTNA, the adverse event rate is also significantly lower. Third, the yield is dependent on the size of the lesion.

Conclusions

In summary, this meta-analysis, based on 39 studies with > 3,000 patients spanning the past decade, shows that guided bronchoscopy for evaluation of PN provides a reasonably high diagnostic yield with a low side-effect profile. The release of the NLST findings and the continued interest in radiographic lung cancer screening will likely lead to an increase in the number of PN identified. As the current modalities evolve and new technologies are developed, the capability of bronchoscopy to reach

Acknowledgments

Author contributions: Dr Wang Memoli: contributed to the study concept and design, analysis and interpretation of the data, and drafting of the manuscript.

Dr Nietert: contributed to the analysis and interpretation of the data, and drafting of the manuscript.

Dr Silvestri: contributed to the study concept and design, analysis and interpretation of the data, and drafting of the manuscript.

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr

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    Funding/Support: This publication was supported by the South Carolina Clinical and Translational Research Institute, Medical University of South Carolina's Clinical Translational Science Award, and the National Institutes of Health/National Center for Research Resources [Grant UL1RR029882].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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