背景:在过去的十年中,导航支气管镜检查在新的导航技术和利用不同技术和工具的多模态方法方面得到了迅速发展。本系统评价分析了导航支气管镜诊断怀疑肺癌的周围性肺结节的诊断率和安全性。
方法:在Embase中进行了广泛的搜索,Medline和CochraneCENTRAL在2022年5月。合格的研究使用锥形束CT导航(CBCT),电磁导航(EMN),机器人导航(RB)或虚拟支气管镜(VB)作为主要的导航技术。主要结果是诊断结果和不良事件。使用QUADAS-2评估研究质量。进行随机效应荟萃分析,对不同的导航技术进行分组分析,较新的技术与较旧的技术,结节大小,出版年份,诊断产量定义的严格性。对结节大小和支气管征的研究报告的亚组进行了探索性分析。
结果:共纳入95项研究(n=10,381例患者;n=10,682个结节)。大多数(n=63;66.3%)在至少一个QUADAS-2域中存在较高的偏倚或适用性风险。总诊断率为70.9%(95%-CI68.4%-73.2%)。总体气胸发生率为2.5%。使用先进成像和/或机器人技术的较新导航技术(CBCT,RB,与更长的既定技术(EMN,VB;n=82项研究):77.5%(95%-CI74.7%-80.1%)vs68.8%(95%-CI65.9%-71.6%)(p<0.001)。探索性亚组分析表明,较大的结节大小和支气管征象的存在与统计学上显着的较高诊断率相关。其他亚组分析显示没有显着差异。
结论:导航支气管镜检查是一种安全的手术,具有高诊断产量的潜力,特别是使用较新的技术,如RB,CBCT和断层合成引导的EMN。研究表明大量的异质性,比较困难。结果与相关临床背景的标准化定义将提高未来的可比性。
Navigation bronchoscopy has seen rapid development in the past decade in terms of new navigation techniques and multi-modality approaches utilizing different techniques and tools. This systematic
review analyses the diagnostic yield and safety of navigation bronchoscopy for the diagnosis of peripheral pulmonary nodules suspected of lung cancer.
An extensive search was performed in Embase, Medline and Cochrane CENTRAL in May 2022. Eligible studies used cone-beam CT-guided navigation (CBCT), electromagnetic navigation (EMN), robotic navigation (RB) or virtual bronchoscopy (VB) as the primary navigation technique. Primary outcomes were diagnostic yield and adverse events. Quality of studies was assessed using QUADAS-2. Random effects meta-analysis was performed, with subgroup analyses for different navigation techniques, newer versus older techniques, nodule size, publication year, and strictness of diagnostic yield definition. Explorative analyses of subgroups reported by studies was performed for nodule size and bronchus sign.
A total of 95 studies (n = 10,381 patients; n = 10,682 nodules) were included. The majority (n = 63; 66.3%) had high risk of bias or applicability concerns in at least one QUADAS-2 domain. Summary diagnostic yield was 70.9% (95%-CI 68.4%-73.2%). Overall pneumothorax rate was 2.5%. Newer navigation techniques using advanced imaging and/or robotics(CBCT, RB, tomosynthesis guided EMN; n = 24 studies) had a statistically significant higher diagnostic yield compared to longer established techniques (EMN, VB; n = 82 studies): 77.5% (95%-CI 74.7%-80.1%) vs 68.8% (95%-CI 65.9%-71.6%) (p < 0.001).Explorative subgroup analyses showed that larger nodule size and bronchus sign presence were associated with a statistically significant higher diagnostic yield. Other subgroup analyses showed no significant differences.
Navigation bronchoscopy is a safe procedure, with the potential for high diagnostic yield, in particular using newer techniques such as RB, CBCT and tomosynthesis-guided EMN. Studies showed a large amount of heterogeneity, making comparisons difficult. Standardized definitions for outcomes with relevant clinical context will improve future comparability.