Cargando…

Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review

BACKGROUND: Convenient approaches for accurate biopsy are extremely important to the diagnosis of lung cancer. We aimed to systematically review the clinical updates and development trends of approaches for biopsy, i.e., CT-guided PTNB (Percutaneous Transthoracic Needle Biopsy), ENB (Electromagnetic...

Descripción completa

Detalles Bibliográficos
Autores principales: Deng, Chuan-Jiang, Dai, Fu-Qiang, Qian, Kai, Tan, Qun-You, Wang, Ru-Wen, Deng, Bo, Zhou, Jing-Hai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122670/
https://www.ncbi.nlm.nih.gov/pubmed/30176840
http://dx.doi.org/10.1186/s12890-018-0713-6
_version_ 1783352699537850368
author Deng, Chuan-Jiang
Dai, Fu-Qiang
Qian, Kai
Tan, Qun-You
Wang, Ru-Wen
Deng, Bo
Zhou, Jing-Hai
author_facet Deng, Chuan-Jiang
Dai, Fu-Qiang
Qian, Kai
Tan, Qun-You
Wang, Ru-Wen
Deng, Bo
Zhou, Jing-Hai
author_sort Deng, Chuan-Jiang
collection PubMed
description BACKGROUND: Convenient approaches for accurate biopsy are extremely important to the diagnosis of lung cancer. We aimed to systematically review the clinical updates and development trends of approaches for biopsy, i.e., CT-guided PTNB (Percutaneous Transthoracic Needle Biopsy), ENB (Electromagnetic Navigation Bronchoscopy), EBUS-TBNA (Endobroncheal Ultrasonography-Transbronchial Needle Aspiration), mediastinoscopy and CTC (Circulating Tumor Cell). METHODS: Medline and manual searches were performed. We identified the relevant studies, assessed study eligibility, evaluated methodological quality, and summarized diagnostic yields and complications regarding CT-guided PTNB (22 citations), ENB(31 citations), EBUS-TBNA(66 citations), Mediastinoscopy(15 citations) and CTC (19 citations), respectively. RESULTS: The overall sensitivity and specificity of CT-guided PTNB were reported to be 92.52% ± 3.14% and 97.98% ± 3.28%, respectively. The top two complications of CT-guided PTNB was pneumothorax (946/4170:22.69%) and hemorrhage (138/1949:7.08%). The detection rate of lung cancer by ENB increased gradually to 79.79% ± 15.34% with pneumothorax as the top one complication (86/1648:5.2%). Detection rate of EBUS-TBNA was 86.06% ± 9.70% with the top three complications, i.e., hemorrhage (53/8662:0.61%), pneumothorax (46/12432:0.37%) and infection (34/11250:0.30%). The detection rate of mediastinoscopy gradually increased to 92.77% ± 3.99% with .hoarseness as the refractory complication (4/2137:0.19%). Sensitivity and specificity of CTCs detection by using PCR (Polymerase Chain Reaction) were reported to be 78.81% ± 14.72% and 90.88% ± 0.53%, respectively. CONCLUSION: The biopsy approaches should be chosen considering a variety of location and situation of lesions. CT-guided PTNB is effective to reach lung parenchyma, however, diagnostic accuracy and incidence of complications may be impacted by lesion size or needle path length. ENB has an advantage for biopsy of smaller and deeper lesions in lung parenchyma. ENB plus EBUS imaging can further improve the detection rate of lesion in lung parenchyma. EBUS-TBNA is relatively safer and mediastinoscopy provides more tissue acquisition and better diagnostic yield of 4R and 7th lymph node. CTC detection can be considered for adjuvant diagnosis.
format Online
Article
Text
id pubmed-6122670
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-61226702018-09-10 Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review Deng, Chuan-Jiang Dai, Fu-Qiang Qian, Kai Tan, Qun-You Wang, Ru-Wen Deng, Bo Zhou, Jing-Hai BMC Pulm Med Research Article BACKGROUND: Convenient approaches for accurate biopsy are extremely important to the diagnosis of lung cancer. We aimed to systematically review the clinical updates and development trends of approaches for biopsy, i.e., CT-guided PTNB (Percutaneous Transthoracic Needle Biopsy), ENB (Electromagnetic Navigation Bronchoscopy), EBUS-TBNA (Endobroncheal Ultrasonography-Transbronchial Needle Aspiration), mediastinoscopy and CTC (Circulating Tumor Cell). METHODS: Medline and manual searches were performed. We identified the relevant studies, assessed study eligibility, evaluated methodological quality, and summarized diagnostic yields and complications regarding CT-guided PTNB (22 citations), ENB(31 citations), EBUS-TBNA(66 citations), Mediastinoscopy(15 citations) and CTC (19 citations), respectively. RESULTS: The overall sensitivity and specificity of CT-guided PTNB were reported to be 92.52% ± 3.14% and 97.98% ± 3.28%, respectively. The top two complications of CT-guided PTNB was pneumothorax (946/4170:22.69%) and hemorrhage (138/1949:7.08%). The detection rate of lung cancer by ENB increased gradually to 79.79% ± 15.34% with pneumothorax as the top one complication (86/1648:5.2%). Detection rate of EBUS-TBNA was 86.06% ± 9.70% with the top three complications, i.e., hemorrhage (53/8662:0.61%), pneumothorax (46/12432:0.37%) and infection (34/11250:0.30%). The detection rate of mediastinoscopy gradually increased to 92.77% ± 3.99% with .hoarseness as the refractory complication (4/2137:0.19%). Sensitivity and specificity of CTCs detection by using PCR (Polymerase Chain Reaction) were reported to be 78.81% ± 14.72% and 90.88% ± 0.53%, respectively. CONCLUSION: The biopsy approaches should be chosen considering a variety of location and situation of lesions. CT-guided PTNB is effective to reach lung parenchyma, however, diagnostic accuracy and incidence of complications may be impacted by lesion size or needle path length. ENB has an advantage for biopsy of smaller and deeper lesions in lung parenchyma. ENB plus EBUS imaging can further improve the detection rate of lesion in lung parenchyma. EBUS-TBNA is relatively safer and mediastinoscopy provides more tissue acquisition and better diagnostic yield of 4R and 7th lymph node. CTC detection can be considered for adjuvant diagnosis. BioMed Central 2018-09-03 /pmc/articles/PMC6122670/ /pubmed/30176840 http://dx.doi.org/10.1186/s12890-018-0713-6 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Deng, Chuan-Jiang
Dai, Fu-Qiang
Qian, Kai
Tan, Qun-You
Wang, Ru-Wen
Deng, Bo
Zhou, Jing-Hai
Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review
title Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review
title_full Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review
title_fullStr Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review
title_full_unstemmed Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review
title_short Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review
title_sort clinical updates of approaches for biopsy of pulmonary lesions based on systematic review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122670/
https://www.ncbi.nlm.nih.gov/pubmed/30176840
http://dx.doi.org/10.1186/s12890-018-0713-6
work_keys_str_mv AT dengchuanjiang clinicalupdatesofapproachesforbiopsyofpulmonarylesionsbasedonsystematicreview
AT daifuqiang clinicalupdatesofapproachesforbiopsyofpulmonarylesionsbasedonsystematicreview
AT qiankai clinicalupdatesofapproachesforbiopsyofpulmonarylesionsbasedonsystematicreview
AT tanqunyou clinicalupdatesofapproachesforbiopsyofpulmonarylesionsbasedonsystematicreview
AT wangruwen clinicalupdatesofapproachesforbiopsyofpulmonarylesionsbasedonsystematicreview
AT dengbo clinicalupdatesofapproachesforbiopsyofpulmonarylesionsbasedonsystematicreview
AT zhoujinghai clinicalupdatesofapproachesforbiopsyofpulmonarylesionsbasedonsystematicreview