Transthoracic needle aspiration biopsy for the diagnosis of localised pulmonary lesions: a meta-analysis

Abstract

Background-Persisting controversy surrounds the use of transthoracic needle aspiration biopsy (TNAB) stemming from its uncertain diagnostic accuracy. A systematic review and meta-analysis was therefore conducted to evaluate the accuracy of TNAB for the diagnosis of solitary or multiple localised pulmonary lesions. Methods-Searches for English literature papers in Index Medicus (1963)(1964)(1965) and Medline (1966Medline ( -1996 were performed and the bibliographies of the retrieved articles were systematically reviewed. Articles evaluating the accuracy of TNAB in series of consecutive patients presenting with solitary or multiple pulmonary lesions were considered. Only papers in which >90% of patients were given a final diagnosis according to an appropriate reference standard were included in the meta-analysis. Results-A total of 48 studies were included and five meta-analyses were conducted according to four diagnostic thresholds. From the pooled sensitivity and specificity corresponding to each diagnostic threshold, associated likelihood ratios (LRs) were derived for malignant disease as follows: (1) malignant versus all other categories, LR = 72; (2) malignant or suspicious versus all others, LR = 49; (3) suspicious versus all categories but malignant, LR = 15; (4) benign versus all others, LR = 0.07; and (5) specific benign diagnosis versus all others, LR = 0.005. DiVerences in methodological quality of the studies, needle types, or whether a cytopathologist participated in the procedure failed to explain the heterogeneity of the results found in almost every metaanalysis. Given a 50% probability of malignancy prior to the TNAB, post-test probabilities of malignancy upon receiving the results would be malignant, 99%; suspicious, 94%; non-specific benign, 7%; and benign with a specific diagnosis, 0.6%. Conclusions-Given the intermediate pre-test probabilities that would probably lead to performing TNAB, findings of "malignant" or of a specific diagnosis of a benign condition provide definitive results. Findings of "suspicious" markedly increase the probability of malignancy, and "benign" markedly decreases it but may not be considered definitive.

Ultrathin Bronchoscopy as an Adjunct to Standard Bronchoscopy in the Diagnosis of Peripheral Lung Lesions

“…A recent meta-analysis by Lacasse et al [14]on the role of transthoracic needle aspiration cytology on the diagnosis of localized pulmonary lesion has put forward that the ‘suspicious’ findings on cytology specimens markedly increase the probability of malignancy, with a likelihood ratio of 15. However, Johnson [15]reviewed a series of 205 patients with the diagnosis of ‘suspicious’ of cancer and found that 32% of those cytological samples were subsequently found to have a benign cause.…”

How I manage pulmonary nodular lesions and nodular infiltrates in patients with hematologic malignancies or undergoing hematopoietic cell transplantation

“…The yield is high for malignancy but much lower for benign lesions. [63][64][65] Bleeding and pneumothorax are the major risks. Pneumothorax occurs in 15% to 24% of instances and requires a chest tube in 6% to 7%.…”

“…Pneumothorax occurs in 15% to 24% of instances and requires a chest tube in 6% to 7%. 65,66 Thus, TTNA would be ill advised in patients with poor lung reserve. Studies in HM and HCT patients indicate a lower yield in the range of 50% to 78%, where the likelihood of malignant etiologies is less.…”

Transthoracic needle aspiration in solitary pulmonary nodule

“…As many as 29% of patients whose conditions were not diagnosed as malignant on trans-thoracic needle biopsy were ultimately found to have carcinoma (5). According to literature reports, the sensitivity and specificity of lung biopsy are separately 86% and 98.8% while its sensitivity and specificity can reach 91%, 94% by combining with perspective and CT guidance (7,8). The accuracy of puncture is evidently related to the location, depth and size of lesions; for nodules <2 cm, the total diagnosis accuracy of CT-guided puncture is about 77.2% (9); while for Figure 2A, showing an expansible lesion within a rib; as the patient was asymptomatic with normal blood parameters, the consensus was to follow the lesion with a roentgenogram.…”