In:
Respiration, S. Karger AG, Vol. 87, No. 2 ( 2014), p. 165-176
Kurzfassung:
〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 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. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 To describe ENB's yield and safety profile. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 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. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 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. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 ENB is effective and particularly safe. Prospective studies are needed to clarify the role of several variables conditioning the yield of this technique.
Materialart:
Online-Ressource
ISSN:
0025-7931
,
1423-0356
Sprache:
Englisch
Verlag:
S. Karger AG
Publikationsdatum:
2014
ZDB Id:
1464419-8
