Diagnostic Yield and Safety of Electromagnetic Navigation Bronchoscopy for Lung Nodules: A Systematic Review and Meta-Analysis
Top Cited Papers
- 31 December 2013
- journal article
- review article
- Published by S. Karger AG in Respiration
- Vol. 87 (2), 165-176
- https://doi.org/10.1159/000355710
Abstract
Background: Electromagnetic navigation bronchoscopy (ENB) is an emerging endoscopic technique for the diagnosis of peripheral lung lesions. A thorough analysis of ENB's yield and safety is required for comparison to other sampling modalities. Objectives: To describe ENB's yield and safety profile. Methods: The MEDLINE and EMBASE databases were systematically searched for studies reporting ENB's yield for peripheral lung lesions. Two independent investigators extracted data and rated each study on a scale of methodological quality. Clearly defined performance outcomes were reconstructed and meta-analyzed. Subgroup analysis and meta-regression were used to identify possible sources of study heterogeneity. Results: A total of 15 trials were included (1,033 lung nodules). A positive and definitive diagnosis was obtained after 64.9% of all ENB procedures (95% CI 59.2-70.3). Overall diagnostic accuracy was 73.9% (95% CI 68.0-79.2). Sensitivity to detect cancer was 71.1% (95% CI 64.6-76.8), with a negative predictive value of 52.1% (95% CI 43.5-60.6). Pneumothorax occurred in 3.1% of patients, requiring chest tube drainage in 1.6% of these cases. Original trials identified 6 variables associated with higher ENB yields: nodule location in the upper or middle lobes, nodule size, lower registration error, presence of a bronchus sign on CT imaging, combined use of an ultrasonic radial probe, and catheter suctioning as a sampling technique. Heterogeneity exploration revealed that studies using general anesthesia or rapid on- site cytological evaluation reported better yields. Conclusions: ENB is effective and particularly safe. Prospective studies are needed to clarify the role of several variables conditioning the yield of this technique. (C) 2014 S. Karger AG, BaselKeywords
This publication has 34 references indexed in Scilit:
- Electromagnetic Navigation Diagnostic Bronchoscopy for Peripheral Lung Lesions and Mediastinal Lymph Nodes: First ResultsTurkish Thoracic Journal/Türk Toraks Dergisi, 2011
- Electromagnetic Navigational BronchoscopyJournal of Bronchology & Interventional Pulmonology, 2011
- Comparison of Suction Catheter versus Forceps Biopsy for Sampling of Solitary Pulmonary Nodules Guided by Electromagnetic Navigational BronchoscopyRespiration, 2009
- Accuracy and Feasibility of Electromagnetic Navigated Bronchoscopy under Nitrous Oxide Sedation for Pulmonary Peripheral Opacities: An Outpatient StudyRespiration, 2009
- Electromagnetic Navigational Bronchoscopy: A Surgeon’s PerspectiveThe Annals of Thoracic Surgery, 2008
- Evaluation of Patients With Pulmonary Nodules: When Is It Lung Cancer?: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition)Social psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2007
- Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesionsEuropean Respiratory Journal, 2007
- Electromagnetic Navigation Diagnostic BronchoscopyAmerican Journal of Respiratory and Critical Care Medicine, 2006
- Measuring inconsistency in meta-analysesBMJ, 2003
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986