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. 2017 Mar 19:82:152-160.
doi: 10.12659/PJR.899626. eCollection 2017.

A Systematic Review and Meta-Analysis of C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Nodules

Gao-Wu Yan  1 , Anup Bhetuwal  1 , Gao-Wen Yan  2 , Qin-Quan Sun  1 , Xiang-Ke Niu  3 , Yu Zhou  4 , Li-Fa Li  5 , Bin-Zhong Li  6 , Hao Zeng  7 , Chuan Zhang  1 , Bing Li  1 , Xiao-Xue Xu  1 , Han-Feng Yang  1 , Yong Du  1
Affiliations

A Systematic Review and Meta-Analysis of C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Nodules

Gao-Wu Yan et al. Pol J Radiol. .

Abstract

Background: A systematic review and meta-analysis of all available publications was performed to evaluate the diagnostic accuracy of percutaneous transthoracic needle biopsy (PTNB) using a C-Arm Cone-Beam CT (CBCT) system in patients with lung nodules.

Material/methods: Thedatabases of PUBMED, OVID, EBSCO, EMBASE, and China National Knowledge Infrastructure (CNKI) were systematically searched for relevant original articles on the diagnostic accuracy of CBCT-guided PTNB for the diagnosis of nodules in the lungs. Diagnostic indices including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and diagnostic score (DS) were calculated. Moreover,summary receiver operating characteristic curves (SROC) were constructed with Stata (version 13.0), Rev Man (version 5.3), and Meta-disc (version 1.4) software. Other clinical indices such as incidence of complications were also recorded.

Results: Eight studies met the inclusion and exclusion criteria for the meta-analysis. The pooled sensitivity, specificity, PLR, NLR, DOR, DS, and SROC with 95% confidence intervals were 0.96 (0.93-0.98), 1.00 (0.91-1.00), 711.15 (9.48-53325.89), 0.04 (0.02-0.07), 16585.29 (284.88-9.7e+05), 9.72 (5.65-13.78), and 0.99 (0.97-0.99), respectively. The incidence of pneumothorax and hemorrhage was 10-29.27% and 1.22-47.25%, respectively.

Conclusions: CBCT-guided PTNB has an acceptable rate of complications and is associated with a reasonable radiation exposure. Moreover, it is a highly accurate and safe technique for the diagnosis of lung nodules and can be recommended to be used in routine clinical practice.

Keywords: Biopsy; Cone-Beam Computed Tomography; Lung; Review.

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Conflict of interest statement

Conflict of interest The authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of study selection.
Figure 2
Figure 2
Quality assessment of diagnostic accuracy studies and criteria for included studies.
Figure 3
Figure 3
Forest plot shows sensitivity(Sen) and specificity(Spe) from the eight studies and pooled estimates. Pooled Sen and Spe were 0.96 (95% CI, 0.93–0.98) and 1.00 (95% CI, 0.91–1.00), respectively.
Figure 4
Figure 4
Forest plot shows positive likelihood ratio(+LR) and negative likelihood ratio(−LR) from the eight studies and pooled estimates. Pooled +LR and −LR were 711.15 (95CI, 9.48–53325.89) and 0.04 (95CI, 0.02–0.07), respectively.
Figure 5
Figure 5
Forest plot shows diagnostic odds ratio (DOR) from the eight studies and pooled estimates. Pooled DOR was 16585.29 (95%CI: 284.88–9.7e+05).
Figure 6
Figure 6
Forest plot shows diagnostic score (DS) from the eight studies and pooled estimates. Pooled DS was 9.72 (95%CI: 5.65–13.78).
Figure 7
Figure 7
Summary receiver operating characteristic (SROC) curve. Area under the SROC cure (AUC)was 1.00 (95%CI: 0.97–0.99).
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