Diagnostic Value of C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Nodules: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 YANGao-wu ¹ , YANGao-wen ⁴ , HUHai ¹ , SUNQing-quan ¹ , WANGXin-lin ¹ , ZHOUYu ³ , WANGJin-liang ¹ , LIBing ² ,  YANGHan-feng ^1,2

1. Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China;
2. Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China;
3. Department of Cardio-Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China;
4. Department of Radiology, The First People's Hospital of Suining, Suining 629000, China;

Corresponding?author：

YANGHan-feng, Email: 505254007@qq.com

Keywords：

Lung nodules; Percutaneous transthoracic needle biopsy; C-arm cone-beam CT; Meta-analysis; Diagnostic test

DOI：

10.7507/1672-2531.20150227

Video：

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Objective To systematically review the diagnostic accuracy of C-arm cone-beam CT (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) for lung nodules. Methods We electronically searched databases including PubMed, EMbase, EBSCO, Ovid, CBM, VIP, WanFang Data and CNKI from inception to Feb 28th, 2015, to collect diagnostic studies of CBCT-guided PTNB for lung nodules. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies by QUADAS-1 tool. Then, meta-analysis was performed by Stata 12.0 and Meta-DiSc 1.4 softwares for calculating pooled sensitivity (Sen), specificity (Spe), positive likelihood ration (+LR), negative likelihood ration (-LR), and diagnostic odds ratio (DOR), drawing summary receiver operating characteristic (SROC) curve and estimating area under the curve (AUC). Results A total of 9 studies involving 1 815 patients were included. The results of meta-analysis showed that the pooled Sen, Spe, +LR,-LR, and DOR were 0.95 (95%CI 0.92 to 0.96), 1.00 (95%CI 0.66 to 1.00), 2 076.58 (95%CI 1.8 to 2.3e+0.6), 0.05 (95%CI 0.04 to 0.08), and 39 443.88 (95%CI 30.53 to 5.1e+0.7), respectively. The AUC of SROC was 0.97 (95%CI 0.95 to 0.98). Conclusion CBCT-guided PTNB can be used as one of the primary examination approaches for lung nodules with relatively high diagnostic accuracy. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： YANGao-wu, YANGao-wen, HUHai, SUNQing-quan, WANGXin-lin, ZHOUYu, WANGJin-liang, LIBing, YANGHan-feng. Diagnostic Value of C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Nodules: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(12): 1387-1392. doi: 10.7507/1672-2531.20150227 Copy

1.	Winn N, Spratt J, Wright E, et al. Patient reported experiences of CT guided lung biopsy:a prospective cohort study. Multidiscip Respir Med, 2014, 9(1):53.
2.	沈健, 陳瓏, 倪才方, 等. CT引導下經皮穿刺同軸活檢術在肺部病變診斷中的應用. 實用放射學雜志, 2014, 30(1):108-112.
3.	Sayyouh M, Vummidi DR, Kazerooni EA. Evaluation and management of pulmonary nodules:state-of-the-art and future perspectives. Expert Opin Med Diagn, 2013, 7(6):629-644.
4.	黃大鋇, 李曉群, 文自祥, 等. C臂CT在肺小結節經皮肺穿刺活檢中的臨床應用. 介入放射學雜志, 2012, 21(9):770-774.
5.	Wallace MJ, Kuo MD, Glaiberman C, et al. Three-dimensional C-arm cone-beam CT:applications in the interventional suite. J Vasc Interv Radiol, 2008, 19(9):799-813.
6.	張高尚, 李曉群, 張健, 等. C臂CT在肺孤立性結節胸腔鏡切除術術前定位中的應用. 介入放射學, 2012, 21(10):829-832.
7.	張勇, 李曉群, 黃大鋇, 等. C型臂CT在肺結節活檢術中的應用價值. 中國介入影像與治療學, 2012, 9(10):707-710.
8.	Hwang HS, Chung MJ, Lee JW, et al. C-arm cone-beam CT-guided percutaneous transthoracic lung biopsy:usefulness in evaluation of small pulmonary nodules. AJR Am J Roentgenol. 2010, 195(6): W400-407.
9.	Jin KN, Park CM, Goo JM, et al. Initial experience of percutaneous transthoracic needle biopsy of lung nodules using C-arm cone-beam CT systems. Eur Radiol, 2010, 20(9):2108-2115.
10.	Cheung JY, Kim Y, Shim SS, et al. Combined fluoroscopy and CTguided transthoracic needle biopsy using a C-arm cone beam CT system:comparison with fluoroscopy-guided biopsy. Korean J Radiol, 2011, 12(1):89-96.
11.	Braak SJ, Herder GJ, van Heesewijk JP, et al. Pulmonary masses: initial results of cone-beam CT guidance with needle planning software for percutaneous lung biopsy. Cardiovasc Intervent Radiol, 2012, 35(6):1414-1421.
12.	Lee WJ, Chong S, Seo JS, et al. Transthoracic fine-needle aspiration biopsy of the lungs using a C-arm cone-beam CT system:diagnostic accuracy and post-procedural complications. Br J Radiol, 2012, 85(1014):e217-222.
13.	Choo JY, Park CM, Lee NK, et al. Percutaneous transthoracic needle biopsy of small (≤ 1 cm) lung nodules under C-arm cone-beam CT virtual navigation guidance. Eur Radiol, 2013, 23(3):712-719.
14.	Choi JW, Park CM, Goo JM, et al. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of small (≤ 20 mm) lung nodules:diagnostic accuracy and complications in 161 patients. AJR Am J Roentgenol, 2012, 199(3):W322-330.
15.	Lee SM, Park CM, Lee KH, et al. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules:clinical experience in 1108 patients. Radiology, 2014, 271(1):291-300.
16.	Floridi C, Muollo A, Fontana F, et al. C-arm cone-beam computed tomography needle path overlay for percutaneous biopsy of pulmonary nodules. Radiol Med, 2014, 119(11):820-827.
17.	Whiting P, Rutjes AW, Reitsma JB, et al. The development of QUADAS:a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol, 2003, 3(4):25-35.
18.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327 (7414):557-560.
19.	Kim HC. Role of C-Arm Cone-Beam CT in Chemoembolization for Hepatocellular Carcinoma. Korean J Radiol, 2015, 16(1):114-124.
20.	Erovic BM, Chan HH, Daly MJ, et al. Intraoperative cone-beam computed tomography and multi-slice computed tomography in temporal bone imaging for surgical treatment. Otolaryngol Head Neck Surg, 2014, 150(1):107-114.
21.	Micames CG, McCrory DC, Pavey DA, et al. Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging:A systematic review and Meta analysis. Chest, 2007, 131(2):539-548.
22.	Gu P, Zhao YZ, Jiang LY, et al. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer:a systematic review and meta-analysis. Eur J Cancer, 2009, 45(8): 1389-1396.
23.	Yang JS, Liu YM, Mao YM, et al. Meta-analysis of CT-guided transthoracic needle biopsy for the evaluation of the ground-glass opacity pulmonary lesions. Br J Radiol, 2014, 87(1042):20140276.
24.	Deeks JJ. Systematic reviews in health care:systematic reviews of evaluations of diagnostic and screening tests. BMJ, 2001, 323(7215): 157-162.
25.	楊肖華, 黃新宇, 汪國祥. CT引導下經皮肺穿刺活檢術并發癥的影響因素分析. 介入放射學雜志, 2013, 22(8):658-662.
26.	許澤兵, 翟昭華, 何菲, 等. CT引導下經皮肺穿刺活檢并發癥的相關因素Logistic分析. 川北醫學院學報, 2012, 26(2):167-171.
27.	Li Y, Du Y, Yang HF, et al. CT-guided percutaneous core needle biopsy for small (≤ 20 mm) pulmonary lesions. Clin Radiol, 2013, 68(1):e43-48.
28.	Niu XK, Bhetuwal A, Yang HF. CT-guided core needle biopsy of pleural lesions:evaluating diagnostic yield and associated complications. Korean J Radiol, 2015, 16(1):206-212.
29.	De Filippo M, Saba L, Concari G, et al. Predictive factors of diagnostic accuracy of CT-guided transthoracic fine-needle aspiration for solid noncalcified, subsolid and mixed pulmonary nodules. Radiol Med, 2013, 118(7):1071-1081.
30.	Braak SJ, van Strijen MJ, van Es HW, et al. Effective dose during needle interventions:cone-beam CT guidance compared with conventional CT guidance. J Vasc Interv Radiol, 2011, 22(34):455-461.

1. Winn N, Spratt J, Wright E, et al. Patient reported experiences of CT guided lung biopsy:a prospective cohort study. Multidiscip Respir Med, 2014, 9(1):53.
2. 沈健, 陳瓏, 倪才方, 等. CT引導下經皮穿刺同軸活檢術在肺部病變診斷中的應用. 實用放射學雜志, 2014, 30(1):108-112.
3. Sayyouh M, Vummidi DR, Kazerooni EA. Evaluation and management of pulmonary nodules:state-of-the-art and future perspectives. Expert Opin Med Diagn, 2013, 7(6):629-644.
4. 黃大鋇, 李曉群, 文自祥, 等. C臂CT在肺小結節經皮肺穿刺活檢中的臨床應用. 介入放射學雜志, 2012, 21(9):770-774.
5. Wallace MJ, Kuo MD, Glaiberman C, et al. Three-dimensional C-arm cone-beam CT:applications in the interventional suite. J Vasc Interv Radiol, 2008, 19(9):799-813.
6. 張高尚, 李曉群, 張健, 等. C臂CT在肺孤立性結節胸腔鏡切除術術前定位中的應用. 介入放射學, 2012, 21(10):829-832.
7. 張勇, 李曉群, 黃大鋇, 等. C型臂CT在肺結節活檢術中的應用價值. 中國介入影像與治療學, 2012, 9(10):707-710.
8. Hwang HS, Chung MJ, Lee JW, et al. C-arm cone-beam CT-guided percutaneous transthoracic lung biopsy:usefulness in evaluation of small pulmonary nodules. AJR Am J Roentgenol. 2010, 195(6): W400-407.
9. Jin KN, Park CM, Goo JM, et al. Initial experience of percutaneous transthoracic needle biopsy of lung nodules using C-arm cone-beam CT systems. Eur Radiol, 2010, 20(9):2108-2115.
10. Cheung JY, Kim Y, Shim SS, et al. Combined fluoroscopy and CTguided transthoracic needle biopsy using a C-arm cone beam CT system:comparison with fluoroscopy-guided biopsy. Korean J Radiol, 2011, 12(1):89-96.
11. Braak SJ, Herder GJ, van Heesewijk JP, et al. Pulmonary masses: initial results of cone-beam CT guidance with needle planning software for percutaneous lung biopsy. Cardiovasc Intervent Radiol, 2012, 35(6):1414-1421.
12. Lee WJ, Chong S, Seo JS, et al. Transthoracic fine-needle aspiration biopsy of the lungs using a C-arm cone-beam CT system:diagnostic accuracy and post-procedural complications. Br J Radiol, 2012, 85(1014):e217-222.
13. Choo JY, Park CM, Lee NK, et al. Percutaneous transthoracic needle biopsy of small (≤ 1 cm) lung nodules under C-arm cone-beam CT virtual navigation guidance. Eur Radiol, 2013, 23(3):712-719.
14. Choi JW, Park CM, Goo JM, et al. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of small (≤ 20 mm) lung nodules:diagnostic accuracy and complications in 161 patients. AJR Am J Roentgenol, 2012, 199(3):W322-330.
15. Lee SM, Park CM, Lee KH, et al. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules:clinical experience in 1108 patients. Radiology, 2014, 271(1):291-300.
16. Floridi C, Muollo A, Fontana F, et al. C-arm cone-beam computed tomography needle path overlay for percutaneous biopsy of pulmonary nodules. Radiol Med, 2014, 119(11):820-827.
17. Whiting P, Rutjes AW, Reitsma JB, et al. The development of QUADAS:a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol, 2003, 3(4):25-35.
18. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327 (7414):557-560.
19. Kim HC. Role of C-Arm Cone-Beam CT in Chemoembolization for Hepatocellular Carcinoma. Korean J Radiol, 2015, 16(1):114-124.
20. Erovic BM, Chan HH, Daly MJ, et al. Intraoperative cone-beam computed tomography and multi-slice computed tomography in temporal bone imaging for surgical treatment. Otolaryngol Head Neck Surg, 2014, 150(1):107-114.
21. Micames CG, McCrory DC, Pavey DA, et al. Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging:A systematic review and Meta analysis. Chest, 2007, 131(2):539-548.
22. Gu P, Zhao YZ, Jiang LY, et al. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer:a systematic review and meta-analysis. Eur J Cancer, 2009, 45(8): 1389-1396.
23. Yang JS, Liu YM, Mao YM, et al. Meta-analysis of CT-guided transthoracic needle biopsy for the evaluation of the ground-glass opacity pulmonary lesions. Br J Radiol, 2014, 87(1042):20140276.
24. Deeks JJ. Systematic reviews in health care:systematic reviews of evaluations of diagnostic and screening tests. BMJ, 2001, 323(7215): 157-162.
25. 楊肖華, 黃新宇, 汪國祥. CT引導下經皮肺穿刺活檢術并發癥的影響因素分析. 介入放射學雜志, 2013, 22(8):658-662.
26. 許澤兵, 翟昭華, 何菲, 等. CT引導下經皮肺穿刺活檢并發癥的相關因素Logistic分析. 川北醫學院學報, 2012, 26(2):167-171.
27. Li Y, Du Y, Yang HF, et al. CT-guided percutaneous core needle biopsy for small (≤ 20 mm) pulmonary lesions. Clin Radiol, 2013, 68(1):e43-48.
28. Niu XK, Bhetuwal A, Yang HF. CT-guided core needle biopsy of pleural lesions:evaluating diagnostic yield and associated complications. Korean J Radiol, 2015, 16(1):206-212.
29. De Filippo M, Saba L, Concari G, et al. Predictive factors of diagnostic accuracy of CT-guided transthoracic fine-needle aspiration for solid noncalcified, subsolid and mixed pulmonary nodules. Radiol Med, 2013, 118(7):1071-1081.
30. Braak SJ, van Strijen MJ, van Es HW, et al. Effective dose during needle interventions:cone-beam CT guidance compared with conventional CT guidance. J Vasc Interv Radiol, 2011, 22(34):455-461.

Chinese Journal of Evidence-Based Medicine

Diagnostic Value of C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Nodules: A Meta-analysis

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