Minimally invasive interventions for biopsy of malignancy-suspected pulmonary nodules: a systematic review and meta-analysis.

Autor:	Miotto A; IMD, PhD. Thoracic Surgeon, Assistant Professor, Thoracic Surgery Division, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil., Perfeito JAJ; MD, PhD. Thoracic Surgeon, Associate Professor, Thoracic Surgery Division, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil., Pacheco RL; MD, PhD. Physician, Professor, Centro Universitário São Camilo, São Paulo (SP), Brazil; Researcher, Center of Health Technology Assessment, Hospital Sírio-Libanês São Paulo (SP), Brazil; Researcher, DCenter of Health Technology Assessment, Associação Paulista para o Desenvolvimento da Medicina (SPDM), São Paulo (SP), Brazil., Latorraca COC; PhD. Psychologist, Researcher, Center of Health Technology Assessment, Associação Paulista para o Desenvolvimento da Medicina (SPDM), São Paulo (SP), Brazil., Riera R; MD, PhD. Physician, Adjunct Professor, Discipline of Evidence-Based Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil; Coordinator, Center of Health Technology Assessment, Hospital Sírio-Libanês São Paulo (SP), Brazil.
Jazyk:	angličtina
Zdroj:	Sao Paulo medical journal = Revista paulista de medicina [Sao Paulo Med J] 2023 Apr 17; Vol. 141 (5), pp. e2022543. Date of Electronic Publication: 2023 Apr 17 (Print Publication: 2023).
DOI:	10.1590/1516-3180.2022.0543.R1.01022023
Abstrakt:	Background: Imaging tests are important for diagnosis during the management of pulmonary nodules; however, biopsy is required to confirm the malignancy. Objectives: To compare the effects of different techniques used for the biopsy of a pulmonary nodule. Design and Setting: Systematic review and meta-analysis were conducted using Cochrane methodology in São Paulo, São Paulo, Brazil. Methods: We conducted a systematic review of randomized controlled trials (RCTs) on minimally invasive techniques, including tomography-guided percutaneous biopsy (PERCUT), transbronchial biopsies with fluoroscopy (FLUOR), endobronchial ultrasound (EBUSR), and electromagnetic navigation (NAVIG). The primary outcomes were diagnostic yield, major adverse events, and need for another approach. Results: Seven RCTs were included (913 participants; 39.2% female, mean age: 59.28 years). Little to no increase was observed in PERCUT over FLUOR (P = 0.84), PERCUT over EBUSR (P = 0.32), and EBUSR over NAVIG (P = 0.17), whereas a slight increase was observed in NAVIG over FLUOR (P = 0.17); however, the evidence was uncertain. EBUSR may increase the diagnostic yield over FLUOR (P = 0.34). PERCUT showed little to no increase in all bronchoscopic techniques, with uncertain evidence (P = 0.02). Conclusion: No biopsy method is definitively superior to others. The preferred approach must consider availability, accessibility, and cost, as safety and diagnostic yield do not differ. Further RCTs planned, conducted, and reported with methodological rigor and transparency are needed, and additional studies should assess cost and the correlation between nodule size and location, as well as their association with biopsy results. Systematic Review Registration: PROSPERO database, CRD42018092367 -https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=92367.
Databáze:	MEDLINE
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