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. 2024 Sep 30;16(9):5995-6011.
doi: 10.21037/jtd-24-845. Epub 2024 Sep 6.

Does the guide sheath outperform the non-guide sheath method in endobronchial ultrasound-guided biopsy of peripheral pulmonary lesions?-a meta-analysis

Lingdan Chang #  1 , Hongjin Shi #  2 , Zhifang Ruan  1 , Mengli Fu  1 , Rui Li  1 , Jiaxin Yang  2 , Yanghuang Zheng  2 , Dan Zeng  2 , Xiaojie He  1 , Xiaona Wang  1 , Jinsong Zhang  2 , Bing Hai  1
Affiliations

Does the guide sheath outperform the non-guide sheath method in endobronchial ultrasound-guided biopsy of peripheral pulmonary lesions?-a meta-analysis

Lingdan Chang et al. J Thorac Dis. .

Abstract

Background: Endobronchial ultrasound (EBUS)-guided transbronchial biopsy with or without a guide sheath (EBUS-GS or EBUS-nGS) is commonly utilized for the diagnosis of peripheral pulmonary lesions (PPLs). The primary objective of this meta-analysis is to assess the diagnostic yield, surgical time, and safety of EBUS-GS and EBUS-nGS in patients presenting with PPLs, providing valuable insights for clinical decision-making.

Methods: We conducted a systematic search of four databases (PubMed, Embase, Web of Science, Cochrane Library) up to January 2024. Two researchers independently screened the retrieved articles, extracted the data, assessed the quality of the studies, and conducted statistical analysis through Review Manager 5.4 and STATA 14.0. Subgroup analysis was used to explore potential sources of heterogeneity. Publication bias was assessed through funnel plot tests. Sensitivity analyses were also performed to evaluate the robustness of the combined results.

Results: The meta-analysis included data from nine studies comprising 2,898 patients. No publication bias was detected. There was no difference in the overall diagnostic rate of EBUS-GS and EBUS-nGS for PPLs [odds ratio (OR): 0.83, 95% confidence interval (CI): 0.64-1.08, Z-score (Z) =1.37, P=0.17]. Conversely, in cases utilizing a bronchoscope with an outer diameter of 3.0 mm (OR: 0.58, 95% CI: 0.40-0.84, Z=2.86, P=0.004), a 1.7-mm bronchoscope channel (OR: 0.70, 95% CI: 0.51-0.96, Z=2.21, P=0.03), or lesions ≤30 mm in size, or lesions situated in the lower lobe of the lung (OR: 0.59, 95% CI: 0.38-0.91, Z=2.36, P=0.02), the diagnostic rate was higher in the EBUS-nGS group. However, the EBUS-GS group demonstrated a tremendous advantage in terms of safety (OR: 0.64, 95% CI: 0.44-0.93, Z=2.33, P=0.02).

Conclusions: EBUS-GS and EBUS-nGS showed no significant difference in the overall diagnostic rate for PPLs. When using a bronchoscope with an outer diameter of 3.0 mm or a channel diameter of 1.7 mm, or when lesions are ≤30 mm or located in the lower lobe of the lung, EBUS-nGS demonstrated a higher diagnostic rate, and EBUS-nGS demonstrated a higher diagnostic rate. However, EBUS-GS exhibited more tremendous advantages in terms of safety.

Keywords: Endobronchial ultrasound-guided biopsy (EBUS-guided biopsy); guide sheath (GS); meta-analysis; no guide sheath (nGS); peripheral pulmonary lesions (PPLs).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-845/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of studies identified, excluded, and included.
Figure 2
Figure 2
The quality assessment of the included randomized controlled trials.
Figure 3
Figure 3
Overall diagnosis rate forest plot. EBUS-GS, endobronchial ultrasound-guided transbronchial biopsy with a guide sheath; EBUS-nGS, endobronchial ultrasound-guided transbronchial biopsy without a guide sheath; M-H, Mantel-Haenszel test; CI, confidence interval.
Figure 4
Figure 4
Forest plot based on bronchoscopic outer diameter grouping. EBUS-GS, endobronchial ultrasound-guided transbronchial biopsy with a guide sheath; EBUS-nGS, endobronchial ultrasound-guided transbronchial biopsy without a guide sheath; M-H, Mantel-Haenszel test; CI, confidence interval.
Figure 5
Figure 5
Forest plot based on the grouping of bronchial channel diameter. EBUS-GS, endobronchial ultrasound-guided transbronchial biopsy with a guide sheath; EBUS-nGS, endobronchial ultrasound-guided transbronchial biopsy without a guide sheath; M-H, Mantel-Haenszel test; CI, confidence interval.
Figure 6
Figure 6
Forest plot based on the grouping of lesion size. EBUS-GS, endobronchial ultrasound-guided transbronchial biopsy with a guide sheath; EBUS-nGS, endobronchial ultrasound-guided transbronchial biopsy without a guide sheath; M-H, Mantel-Haenszel test; CI, confidence interval.
Figure 7
Figure 7
Forest plot based on the grouping of different lung lobes. EBUS-GS, endobronchial ultrasound-guided transbronchial biopsy with a guide sheath; EBUS-nGS, endobronchial ultrasound-guided transbronchial biopsy without a guide sheath; M-H, Mantel-Haenszel test; CI, confidence interval.
Figure 8
Figure 8
Forest plot of surgical duration. EBUS-GS, endobronchial ultrasound-guided transbronchial biopsy with a guide sheath; EBUS-nGS, endobronchial ultrasound-guided transbronchial biopsy without a guide sheath; IV, inverse variance; CI, confidence interval.
Figure 9
Figure 9
Forest plot of overall complications. EBUS-GS, endobronchial ultrasound-guided transbronchial biopsy with a guide sheath; EBUS-nGS, endobronchial ultrasound-guided transbronchial biopsy without a guide sheath; M-H, Mantel-Haenszel test; CI, confidence interval.
Figure 10
Figure 10
Forest plot based on the grouping complications. EBUS-GS, endobronchial ultrasound-guided transbronchial biopsy with a guide sheath; EBUS-nGS, endobronchial ultrasound-guided transbronchial biopsy without a guide sheath; M-H, Mantel-Haenszel test; CI, confidence interval.
Figure 11
Figure 11
Forest plot of safety based on bronchoscopic type. EBUS-GS, endobronchial ultrasound-guided transbronchial biopsy with a guide sheath; EBUS-nGS, endobronchial ultrasound-guided transbronchial biopsy without a guide sheath; M-H, Mantel-Haenszel test; CI, confidence interval.
Figure 12
Figure 12
Funnel plot. SE, standard error; OR, odds ratio; MD, mean difference.
Figure 13
Figure 13
Sensitivity analysis. CI, confidence interval.
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