Tissue Adequacy and Safety of Percutaneous Transthoracic Needle Biopsy for Molecular Analysis in Non-Small Cell Lung Cancer: A Systematic Review and Meta-analysis

Abstract

Objective We conducted a systematic review and meta-analysis of the tissue adequacy and complication rates of percutaneous transthoracic needle biopsy (PTNB) for molecular analysis in patients with non-small cell lung cancer (NSCLC). Materials and Methods We performed a literature search of the OVID-MEDLINE and Embase databases to identify original studies on the tissue adequacy and complication rates of PTNB for molecular analysis in patients with NSCLC published between January 2005 and January 2020. Inverse variance and random-effects models were used to evaluate and acquire meta-analytic estimates of the outcomes. To explore heterogeneity across the studies, univariable and multivariable meta-regression analyses were performed. Results A total of 21 studies with 2232 biopsies (initial biopsy, 8 studies; rebiopsy after therapy, 13 studies) were included. The pooled rates of tissue adequacy and complications were 89.3% (95% confidence interval [CI]: 85.6%–92.6%; I 2 = 0.81) and 17.3% (95% CI: 12.1%–23.1%; I 2 = 0.89), respectively. These rates were 93.5% and 22.2% for the initial biopsies and 86.2% and 16.8% for the rebiopsies, respectively. Severe complications, including pneumothorax requiring chest tube placement and massive hemoptysis, occurred in 0.7% of the cases (95% CI: 0%–2.2%; I 2 = 0.67). Multivariable meta-regression analysis showed that the tissue adequacy rate was not significantly lower in studies on rebiopsies ( p = 0.058). The complication rate was significantly higher in studies that preferentially included older adults ( p = 0.001). Conclusion PTNB demonstrated an average tissue adequacy rate of 89.3% for molecular analysis in patients with NSCLC, with a complication rate of 17.3%. PTNB is a generally safe and effective diagnostic procedure for obtaining tissue samples for molecular analysis in NSCLC. Rebiopsy may be performed actively with an acceptable risk of complications if clinically required.

Repeat biopsy versus initial biopsy in terms of complication risk factors and clinical outcomes for patients with non-small cell lung cancer: a comparative study of 113 CT-guided needle biopsy of lung lesions

“…Both pulmonary hemorrhage and pneumothorax in rebiopsy were accepted, and pneumothorax was the most common. Also, a meta-analysis ( 30 ) showed a slight but non-significant reduction in the pooled complication rate for the rebiopsies vs. the initial biopsies (16.8% vs. 22.2%). Although patients showed disease progression after receiving a previous systemic treatment, the overall complication rate of the biopsy was not statistically significant between the two groups.…”

The Scan, the Needle, or the Knife? National Trends in Diagnosing Stage I Lung Cancer

“…16 The association of age and comorbidity score in the current study is consistent with the literature, which reports greater complication rates and reduced health-related quality of life in elderly or medically unfit patients who undergo invasive diagnostic procedures or upfront surgical resection for NSCLC. [17][18][19] A retrospective review of 2,493 patients with lung cancer demonstrated that tissue diagnosis had no significant impact on overall survival or treatment in patients with a higher burden of medical comorbidities or poorer functional status. Moreover, within this subgroup of medically high-risk patients, there was no significant difference in mortality between those who did or did not undergo formal tissue diagnosis.…”

Clinical Role of Upfront F-18 FDG PET/CT in Determining Biopsy Sites for Lung Cancer Diagnosis

“…Over the past few decades, image-guided percutaneous needle biopsy (PNB) for the lung has emerged as the preferred procedure for lung cancer diagnosis [1,2]. Compared to transbronchial or surgical biopsy, PNB under CT, US, and fluoroscopy guidance can be performed easily under local anesthesia, without the need for general anesthesia [3][4][5][6]. PNB for the lung has limitations due to the potential risk of pneumothorax in approximately 15-38% of patients, with a subsequent requirement for chest tube insertion in approximately 5-10% of patients [3,5,7].…”

“…Compared to transbronchial or surgical biopsy, PNB under CT, US, and fluoroscopy guidance can be performed easily under local anesthesia, without the need for general anesthesia [3][4][5][6]. PNB for the lung has limitations due to the potential risk of pneumothorax in approximately 15-38% of patients, with a subsequent requirement for chest tube insertion in approximately 5-10% of patients [3,5,7]. To avoid the risks of pneumothorax and chest tube placement, a histopathological diagnosis has been obtained through PNB for metastasis involving the pleura, lymph nodes, bones, and solid organs other than the lung [4,[8][9][10][11][12].…”