Photo Credit: Magicmine
The following is a summary of “Diagnostic Yield of Cone Beam Computed Tomography Combined with Radial-Endobronchial Ultrasound for the Diagnosis of Peripheral Pulmonary Nodules: Systematic Review and Meta-analysis,” published in the February 2024 issue of Pulmonology by Brown et al.
With the increasing prevalence of peripheral pulmonary nodules (PPNs) due to advanced imaging and lung cancer screening initiatives, effective diagnostic techniques are essential. Navigational bronchoscopy, including Cone Beam Computed Tomography (CBCT) combined with radial endobronchial ultrasound (r-EBUS), has emerged as a valuable approach for sampling these nodules. This method supplements the traditional use of fluoroscopy with enhanced visualization capabilities.
The study aims to evaluate the efficacy and safety of employing CBCT in conjunction with r-EBUS for diagnosing PPNs.
In March 2023, researchers searched Embase, PubMed, and Cochrane Central databases. The study group identified studies utilizing CBCT with r-EBUS as the primary navigation modality for PPN diagnosis. The primary outcome, diagnostic yield, was analyzed through random effects meta-analysis. Subgroup analyses were conducted based on the incorporation of additional navigational technologies. The risk of bias was evaluated using the Critical Appraisal Skills Programme (CASP) tool, while the quality of outcomes was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.
Their analysis encompassed 14 studies involving 865 patients with 882 lesions. Despite the significant risk of bias identified by the CASP tool due to confounding factors, the pooled diagnostic yield of combined CBCT and r-EBUS guided biopsy for PPN diagnosis was 80% (95%CI 76-84%). Subgroup analysis revealed similar diagnostic yields for CBCT and r-EBUS alone and combined with additional navigational technologies. However, the quality of outcomes assessed by the GRADE tool was generally low to very low. Safety assessments indicated a 2.01% pneumothorax rate and 1.08% bleeding rate, with radiation doses ranging between 19.59Gycm2 and 85.9Gycm2, corresponding to an effective dose range of 3.1 to 13.8mSv.
Combining CBCT with r-EBUS shows promising diagnostic efficacy for PPNs, albeit with varying quality of evidence. Safety profiles indicate acceptable complication rates, underscoring this approach’s potential in clinical practice.
Source: sciencedirect.com/science/article/pii/S2949789224000035