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Meta-Analysis
. 2020 May;11(5):1191-1201.
doi: 10.1111/1759-7714.13373. Epub 2020 Mar 4.

The value of navigation bronchoscopy in the diagnosis of peripheral pulmonary lesions: A meta-analysis

Simin Jiang  1 , Fangfang Xie  2   3   4 , Xiaowei Mao  3 , Haifeng Ma  5 , Jiayuan Sun  2   3   4
Affiliations
Meta-Analysis

The value of navigation bronchoscopy in the diagnosis of peripheral pulmonary lesions: A meta-analysis

Simin Jiang et al. Thorac Cancer. 2020 May.

Abstract

Background: To compare the diagnostic yield of peripheral pulmonary lesions (PPLs) with and without navigation system.

Methods: Studies dating from January 1990 to October 2019 were collected from databases. Diagnostic yield of navigation bronchoscopy and non-navigation bronchoscopy was extracted from comparative studies. Subgroup analysis was adopted to test diagnostic yield variation by lesion size, lobe location of the lesion, distance from the hilum, bronchus sign and nature of the lesion.

Results: In total, 2131 patients from 10 studies were enrolled into the study. Diagnostic yield of navigation bronchoscopy was statistically higher than non-navigation bronchoscopy for PPLs (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.32, 2.18, P < 0.001), particularly for PPLs in the peripheral third lung (OR 2.26, 95% CI 1.48, 3.44, P < 0.001) and for bronchus sign positive PPLs (OR 2.26, 95% CI 1.21, 4.26, P = 0.011). Navigation bronchoscopy had better performance than non-navigation bronchoscopy when PPLs were ≤ 20 mm (OR 2.09, 95% CI 1.44, 3.03, P < 0.001). It also elevated diagnostic yield of malignant PPLs (OR 1.67, 95% CI 1.26, 2.22, P < 0.001) and PPLs in the bilateral upper lobes (OR 1.50, 95% CI 1.09, 2.08, P = 0.014).

Conclusions: Navigation bronchoscopy enhanced diagnostic yield when compared to non-navigation bronchoscopy, particularly for PPLs in the peripheral third lung, PPLs being bronchus sign positive, PPLs ≤ 20 mm, malignant PPLs and PPLs in the bilateral upper lobes.

Key points: The current study provided systematic evaluation on the diagnostic value of navigation bronchoscopy by comparing it with non-navigation bronchoscopy, and exploring the factors affecting the diagnostic yield.

Keywords: Diagnostic yield; electromagnetic navigation bronchoscopy (ENB); peripheral pulmonary lesions (PPLs); transbronchial lung biopsy (TBLB); virtual bronchoscopic navigation (VBN).

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Figures

Figure 1
Figure 1
Study search and selection flow.
Figure 2
Figure 2
Forest plot of diagnostic OR of navigation bronchoscopy to non‐navigation bronchoscopy. CI, confidence interval; NB, navigation bronchoscopy; NON‐NB, non‐navigation bronchoscopy; OR, odds ratio.
Figure 3
Figure 3
Funnel plot. (a) Funnel plot of 10 studies included in analysis of diagnostic OR of navigation bronchoscopy to non‐navigation bronchoscopy graphed by Begg's test. (b) Funnel plot adjusted by Duval's trim and filled test. (formula image) Included studies and (formula image) filled studies.
Figure 4
Figure 4
Forest plot of diagnostic OR of navigation bronchoscopy to non‐navigation bronchoscopy by lesion size.
Figure 5
Figure 5
Forest plot of diagnostic OR of navigation bronchoscopy to non‐navigation bronchoscopy by the lobe location of the lesion. BLLs, bilateral lower lobes; BULs, bilateral upper lobes; RML, right middle lobe.
Figure 6
Figure 6
Forest plot of diagnostic OR of navigation bronchoscopy to non‐navigation bronchoscopy by distance from the lesion to the hilum.
Figure 7
Figure 7
Forest plot of diagnostic OR of navigation bronchoscopy to non‐navigation bronchoscopy by bronchus sign.
Figure 8
Figure 8
Forest plot of diagnostic OR of navigation bronchoscopy to non‐navigation bronchoscopy by nature of the lesion.
See this image and copyright information in PMC

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