Computed Tomography Bronchus Sign and the Diagnostic Yield of Guided Bronchoscopy for Peripheral Pulmonary Lesions. A Systematic Review and Meta-Analysis
- 1 August 2018
- journal article
- review article
- Published by American Thoracic Society in Annals of the American Thoracic Society
- Vol. 15 (8), 978-987
- https://doi.org/10.1513/annalsats.201711-856oc
Abstract
Rationale: Indeterminate peripheral pulmonary lesions often require tissue diagnosis. If non-surgical biopsy techniques are considered, deciding between bronchoscopic transbronchial vs. CT guided transthoracic biopsy can be difficult. The former has a low diagnostic yield with a low complication risk, while the latter has a better diagnostic yield but a higher complication rate. Investigators have looked at various lesion characteristics that can predict the diagnostic yield of guided bronchoscopic biopsies. While consensus exists that larger size and proximity to the hilum increase the diagnostic yield, there is ongoing debate about the association between CT bronchus sign (air-filled bronchus in close proximity of the lesion as seen on CT) and the diagnostic yield of guided bronchoscopic modalities. Objectives: To perform a meta-analysis and systematic review, determining the association between CT bronchus sign and the diagnostic yield of guided bronchoscopy for peripheral pulmonary lesions. Methods: MEDLINE, Embase, Scopus and Google Scholar were searched in January 2018 for guided bronchoscopy studies that had assessed the impact of CT bronchus sign on the diagnostic yield. The quality of included studies was assessed using Quality Assessment, Data Abstraction and Synthesis-2 tool. Meta-analysis was performed using MedCalc (version 18). Odds ratios were used to compare yield of lesions with and without bronchus sign. Random effects model was used when significant heterogeneity was observed (I2>40%). Results: For 2199 lesions with CT bronchus sign, the overall weighted diagnostic yield was 74.1% (95% CI: 68.3-79.5%). For 971 lesions without CT bronchus sign, the overall weighted diagnostic yield was 49.6% (95% CI: 39.6-59.5%). The odds ratio for successfully diagnosing a lesion with CT bronchus was 3.4 (95% CI: 2.4-5.0). Possible sources of heterogeneity in the meta-analysis included differences in study designs, guidance modalities and cancer prevalence. The odds ratio for successfully diagnosing a lesion with CT bronchus sign was relatively lower for prospective studies. Conclusions: Peripheral pulmonary lesions with CT bronchus sign are more likely to be diagnosed with guided bronchoscopy as compared to the lesions without CT bronchus sign. Clinicians should consider this along with the lesion size and distance from hilum, when contemplating guided bronchoscopy for peripheral pulmonary lesions. Objectives: To perform a meta-analysis and systematic review, determining the impact of CT bronchus sign on the diagnostic yield of guided bronchoscopy for peripheral pulmonary lesions. Methods: MEDLINE, Embase, Scopus and Google Scholar were searched in January 2018 for guided bronchoscopy studies that had assessed the impact of CT bronchus sign on the diagnostic yield. The quality of included studies was assessed using Quality Assessment, Data Abstraction and Synthesis-2 tool. Meta-analysis was performed using MedCalc (version 18). Odds ratios were used to compare yield of lesions with and without bronchus sign. Random effects model was used when significant heterogeneity was observed (I2>40%). Results: For 2199 lesions with CT bronchus sign, the overall weighted diagnostic yield was 74.1% (95% CI: 68.3-79.5%). For 971 lesions without CT bronchus, the overall weighted diagnostic yield was 49.6% (95% CI: 39.6-59.5%). The odds ratio for successfully diagnosing a lesion with CT bronchus was 3.4 (95% CI: 2.4-5.0). I² index was 62.1 therefore random effects model was used. Conclusions: Peripheral pulmonary lesions with CT bronchus sign are much more likely to be successfully diagnosed with guided bronchoscopy as compared to the lesions without CT bronchus sign. Clinicians should consider the presence (or absence) of CT bronchus sign along with the size of the lesion and distance from the hilum, when contemplating guided bronchoscopic modalities for peripheral pulmonary lesions.Keywords
This publication has 53 references indexed in Scilit:
- Factors That Affect the Diagnostic Yield of Endobronchial Ultrasonography-Assisted Transbronchial Lung BiopsyJournal of Laparoendoscopic & Advanced Surgical Techniques, 2012
- Electromagnetic Navigational Bronchoscopy in the Diagnosis of Lung LesionsJournal of Bronchology & Interventional Pulmonology, 2012
- Diagnosis of Lung Nodules With Peripheral/Radial Endobronchial Ultrasound-guided Transbronchial BiopsyJournal of Bronchology & Interventional Pulmonology, 2012
- QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy StudiesAnnals of Internal Medicine, 2011
- Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic ScreeningThe New England Journal of Medicine, 2011
- Virtual bronchoscopic navigation combined with endobronchial ultrasound to diagnose small peripheral pulmonary lesions: a randomised trialThorax, 2011
- Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysisEuropean Respiratory Journal, 2010
- The Usefulness of Endobronchial Ultrasonogram for Peripheral Lung LesionTuberculosis and Respiratory Diseases, 2009
- Electromagnetic Navigation Diagnostic BronchoscopyAmerican Journal of Respiratory and Critical Care Medicine, 2006
- Endobronchial ultrasonography with guide-sheath for peripheral pulmonary lesionsEuropean Respiratory Journal, 2004