Computed tomography-guided lung biopsy with rapid on-site evaluation for diagnosis of lung lesions: a meta-analysis

BACKGROUND: Lung biopsy (LB) procedures performed with computed tomography (CT guidance can enable the reliable diagnosis of lung lesions. These diagnostic efforts can be further expedited through a rapid on-site evaluation (ROSE) approach, allowing for the rapid assessment of collected tissue samples to gauge the adequacy of these samples, their features, and associated cytomorphological characteristics. The present analysis was developed to examine the safety and efficacy of CT-guided LB with ROSE as a means of diagnosing lung lesions. METHODS: Studies published as of July 31, 2022 in the PubMed, Embase, and Wanfang databases were identified for this meta-analysis. Diagnostic accuracy was the primary endpoint, while secondary endpoints included the operative duration, the number of punctures, and rates of lung hemorrhage, pneumothorax, and secondary LB. RESULTS: This meta-analysis included 6 total studies. Relative to CT alone, CT with ROSE was associated with a significant increase in diagnostic accuracy (P < 0.00001). In contrast, there were no significant differences between these two groups with respect to the operative duration (P = 0.86), the number of punctures (P = 0.60), or the rates of pneumothorax (P = 0.82) or lung hemorrhage (P = 0.81). Pooled secondary LB rates were significantly lower for patients that underwent CT with ROSE relative to patients in the CT only group (P = 0.0008). Significant heterogeneity was detected for the operative duration (I(2) = 94%) and number of punctures (I(2) = 98%) endpoints, while no publication bias was detected for any study endpoints. CONCLUSIONS: These results suggest that ROSE may contribute to significant improvements in the diagnostic accuracy of CT-guided LB without contributing to higher rates of complications.