Cancer Res Treat.  2024 Apr;56(2):464-483. 10.4143/crt.2023.749.

Development of the Korean Association for Lung Cancer Clinical Practice Guidelines: Recommendations on Radial Probe Endobronchial Ultrasound for Diagnosing Lung Cancer - An Updated Meta-Analysis

• Kim SH
• Chung HS
• Kim J
• Kim MH
• Lee MK
• Kim I
• Eom JS

• KMID: 2554337
• DOI: http://doi.org/10.4143/crt.2023.749

Abstract

Purpose
Radial probe endobronchial ultrasound (RP-EBUS) accurately locates peripheral lung lesions (PLLs) during transbronchial biopsy (TBB). We performed an updated meta-analysis of the diagnostic yield of TBB for PLLs using RP-EBUS to generate recommendations for the development of the Korean Association of Lung Cancer guidelines.
Materials and Methods
We systematically searched MEDLINE and EMBASE (from January 2013 to December 2022), and performed a meta-analysis using R software. The diagnostic yield was evaluated by dividing the number of successful diagnoses by the total lesion number. Subgroup analysis was performed to identify related factors.
Results
Forty-one studies with a total of 13,133 PLLs were included. The pooled diagnostic yield of RP-EBUS was 0.72 (95% confidence interval [CI], 0.70 to 0.75). Significant heterogeneity was observed among studies (χ²=292.38, p < 0.01, I²=86.4%). In a subgroup analysis, there was a significant difference in diagnostic yield based on RP-EBUS findings (within, adjacent to, invisible), with a risk ratio of 1.45 (95% CI, 1.23 to 1.72) between within and adjacent to, 4.20 (95% CI, 1.89 to 9.32) between within and invisible, and 2.59 (95% CI, 1.32 to 5.01) between adjacent to and invisible. There was a significant difference in diagnostic yield based on lesion size, histologic diagnosis, computed tomography (CT) bronchus sign, lesion character, and location from the hilum. The overall complication rate of TBB with RP-EBUS was 6.8% (bleeding, 4.5%; pneumothorax, 1.4%).
Conclusion
Our study showed that TBB with RP-EBUS is an accurate diagnostic tool for PLLs with good safety profiles, especially for PLLs with within orientation on RP-EBUS or positive CT bronchus sign.

Keyword

Bronchoscopy; Lung neoplasms; Meta-analysis; Pulmonary nodule; Radial probe endobronchial ultrasound

Figure

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  Fig. 1. Flow diagram of search and study selection.

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  Fig. 2. Funnel plot of publication bias.

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  Fig. 3. Overall diagnostic yield of radial probe endobronchial ultrasound. CI, confidence interval; IV, inverse variance [22-62].

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  Fig. 4. Diagnostic yield of radial probe endobronchial ultrasound based on sonographic findings [28,31,38,42,45-47,52,53,55,61,62]. (A) Within vs. adjacent to. (B) Within vs. invisible. (C) Adjacent to vs. invisible. CI, confidence interval.

Reference

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