Chest
Original ResearchPulmonary ProceduresMeta-analysis of Guided Bronchoscopy for the Evaluation of the Pulmonary Nodule
Section snippets
Data Sources
An Ovid MEDLINE (1950 through October 2010) and PubMed database search was performed using “bronchoscopy” and “pulmonary nodule” as terms to identify studies. The search was limited to human subjects. Although the search was not limited to English language studies, no non-English language studies met the inclusion criteria. The reference lists of included studies and review articles were searched manually for other relevant studies.
Study Selection
Review articles and commentaries were excluded from the
Results
The MEDLINE and PubMed searches identified 140 and 309 potential studies, respectively. A thorough review of the reference lists of related studies uncovered an additional 29 studies. From these, a total of 39 studies met the inclusion criteria and were included in the analysis (Fig 2). The included studies were published between 2002 and October 2010. All studies reported the diagnostic yield of bronchoscopic biopsy of PN using at least one of five guidance techniques: VB, ENB, R-EBUS, guide
Discussion
This study has several important findings that may influence our current practice and approach to the evaluation and management of PN. First, the pooled diagnostic yield of 70% is much higher than yields reported previously using traditional bronchoscopic techniques.5, 6 Second, although the diagnostic yield for guided bronchoscopic techniques is lower than that reported for TTNA, the adverse event rate is also significantly lower. Third, the yield is dependent on the size of the lesion.
Conclusions
In summary, this meta-analysis, based on 39 studies with > 3,000 patients spanning the past decade, shows that guided bronchoscopy for evaluation of PN provides a reasonably high diagnostic yield with a low side-effect profile. The release of the NLST findings and the continued interest in radiographic lung cancer screening will likely lead to an increase in the number of PN identified. As the current modalities evolve and new technologies are developed, the capability of bronchoscopy to reach
Acknowledgments
Author contributions: Dr Wang Memoli: contributed to the study concept and design, analysis and interpretation of the data, and drafting of the manuscript.
Dr Nietert: contributed to the analysis and interpretation of the data, and drafting of the manuscript.
Dr Silvestri: contributed to the study concept and design, analysis and interpretation of the data, and drafting of the manuscript.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr
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Funding/Support: This publication was supported by the South Carolina Clinical and Translational Research Institute, Medical University of South Carolina's Clinical Translational Science Award, and the National Institutes of Health/National Center for Research Resources [Grant UL1RR029882].
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