Systematic Evaluation of the Diagnostic Value of Computed Tomography-guided Puncture Biopsy Combined with Rapid On-site Evaluation for Pulmonary Lesions
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摘要:
目的：探讨CT引导下穿刺活检联合快速现场评价对肺部病灶的诊断价值。方法：截至2022年10月，系统检索PubMed和EMBASE数据库，查找所有国外公开发表的文献研究，采用PRISMA推荐的质量评价工具（QUADAS-2）作为评估偏倚风险的主要方法，应用Meta分析软件对数据进行异质性检验，根据异质性结果选择相应的效应模型，计算总灵敏度、特异度、诊断优势比（DOR），并绘制综合受试者工作特征曲线（SROC）、森林图与漏斗图。结果：纳入研究6篇（n=951例），采用随机效应模型分析，汇总灵敏度、特异度、诊断优势比及其95％ 置信区间分别为94％、95％、159.05，SROC AUC为0.98。对设立对照组的4项研究进一步分析，与非ROSE组比较，ROSE组取材充分性、诊断准确性分别提高12％和13％。结论：对于肺部病灶，CT引导下穿刺活检联合快速现场评价是一项切实可行的操作方法，可作为重要临床诊断方法之一。
Abstract:Background: To investigate the diagnostic value of computed tomography (CT)-guided aspiration biopsy combined with rapid field evaluation for pulmonary lesions. Methods: The PubMed and EMBASE databases were searched systematically for studies related to the diagnosis of lung lesions by CT-guided puncture biopsy combined with a rapid on-site indexed through October 2022. The updated Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was applied as the main method to assess the risk of bias and applicability of the studies. Meta-analysis software was used to perform heterogeneity tests on the data. Based on the heterogeneity results, the appropriate effect model was selected to calculate the overall sensitivity, specificity, and diagnostic odds ratio (DOR), and to plot the summary receiver operating characteristic (SROC) curve, forest plot, and funnel plot. The results of the analysis of six studies (n=951) using a random-effects model showed pooled sensitivity, specificity, and diagnostic odds ratio with 95% confidence intervals of 94%, 95%, and 159.05, respectively, with an SROC AUC of 0.98. Further analysis of the four studies that established control groups showed that the sampling adequacy and diagnostic accuracy in the ROSE group were 12% and 13% higher than those in the non-ROSE group. In conclusion, CT-guided puncture biopsy combined with rapid on-site evaluation is a practical and feasible method for diagnosing pulmonary lesions and can be used as an important clinical diagnostic method.
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图 2 QUADAS-2质量评价表
Figure 2. Assessment of reporting quality by the QUADAS-2 scoring system
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图 3 CT引导下穿刺活检联合ROSE的汇总灵敏度、特异度、诊断比值比及SRCOC曲线的森林图
Figure 3. Forest plot showing the sensitivity (SEN), specificity (SPE), diagnostic odds ratio (DOR), and summary receiver operating characteristic curve (SROC) of the six studies and the pooled estimates
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图 5 （A）ROSE组与非ROSE组取材充分性的森林图；（B）ROSE组与非ROSE组诊断准确性的森林图；（C）ROSE组与非ROSE组的并发症发生率；RD，风险差异；ROSE，快速现场评价
Figure 5. (A) Forest plot comparing the adequacy rate with or without ROSE in the included studies; (B) Forest plot comparing the accuracy with or without ROSE in the included studies; (C) Forest plot comparing the incidence of complication with or without in the included studies. RD, risk difference; ROSE, rapid on-site evaluation
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图 6 针对6项研究的发表偏倚检测
Figure 6. Deeks' funnel plot asymmetry test for publication bias of the six studies included in the Meta-analysis
表 1 纳入研究文献的基本资料汇总
Table 1 Study characteristics and demographics
Author-year Country Study design No. of
patientsNo. of biopsy Main sampling
sitesRose reagent Rose reporter Sampling
methodAnila et al, 2018 India PCS 50 50 masses toluidine blue pathologist FNA Fassina et al,
2011Italy PCS 311 86 - Giemsa pathologist FNA Liu et al, 2022 China RCT 108 108 nodules Diff-quik pathologist FNA Peng et al, 2020 China RCS 205 205 nodules/masses Diff-quik pathologist FNA Santambrogio et al, 1997 Italy RCT 220 207 nodules Giemsa pathologist FNA Yiminniyaze et al, 2022 China RCS 285 285 nodules/masses Diff-quik pathologist CNB Author-year No. of patients Adequacy Complication(n) Tp Fp Fn Tn R NR R NR R NR Anila et al, 2018 50 － 39 － Pneumothorax(3) － 31 0 3 16 Fassina et al,
2011311 － 305 － Pneumothorax(13)
haemoptysis (4)
Chest pain(3)－ 77 0 3 6 Liu et al, 2022 56 52 52 41 Pneumothorax(6)
haemoptysis (10)Pneumothorax(7)
haemoptysis (11)28 2 4 22 Peng et al, 2020 132 102 － － Pneumothorax(9)
haemoptysis (2)Pneumothorax(15)
haemoptysis (2)57 4 7 64 Santambrogio et al, 1997 110 110 110 97 Pneumothorax(29) Pneumothorax(23) 63 1 7 26 Yiminniyaze et al, 2022 163 122 160 105 Pneumothorax(34)
haemoptysis (21)Pneumothorax(16)
haemoptysis (11)150 0 3 6 注：RCT为随机对照试验；RCS为回顾性研究；PCS为前瞻性研究；ROSE为快速现场评价；NR为未进行快速现场评价。 
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[1] SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA: A Cancer Journal for Clinicians, 2021, 71(3): 209−249. doi: 10.3322/caac.21660
[2] CHUNG C, KIM Y, PARK D. Transthoracic needle biopsy: How to maximize diagnostic accuracy and minimize complications[J]. Tuberculosis and Respiratory Diseases, 2020, 83(S1): S17.
[3] LIU Q H, ARIAS S, WANG K P. International association for the study of lung cancer map, Wang lymph node map and rapid on-site evaluation in transbronchial needle aspiration[J]. Journal of Thoracic Disease, 2016, 8(9): E869. doi: 10.21037/jtd.2016.08.63
[4] MONACO S E, PANTANOWITZ L, KHALBUSS W E. Comparing endobronchial ultrasound-guided fine needle aspiration specimens with and without rapid on-site evaluation[J]. Cytojournal, 2012, 9.
[5] MCINNES M D F, MOHER D, THOMBS B D, et al. Preferred reporting items for a systematic review and Meta-analysis of diagnostic test accuracy studies: The PRISMA-DTA statement[J]. Journal of the American Medical Association, 2018, 319(4): 388−396. doi: 10.1001/jama.2017.19163
[6] WHITING P F, RUTJES A W S, WESTWOOD M E, et al. QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies[J]. Annals of Internal Medicine, 2011, 155(8): 529−536. doi: 10.7326/0003-4819-155-8-201110180-00009
[7] ANILA K R, NAYAK N, VENUGOPAL M, et al. Role of rapid on-site evaluation in CT-guided fine needle aspiration cytology of lung nodules[J]. Journal of Cytology, 2018, 35(4): 229−232. doi: 10.4103/JOC.JOC_134_17
[8] FASSINA A, CORRADIN M, ZARDO D, et al. Role and accuracy of rapid on-site evaluation of CT-guided fine needle aspiration cytology of lung nodules[J]. Cytopathology, 2011, 22(5): 306-312. DOI:10.1111/j.1365-2303.2010.00802.x. PMID: 20738359.
[9] LIU W, XU C, LI L, et al. The value of computed tomography-guided percutaneous lung biopsy combined with rapid on-site evaluation in diagnosis of peripheral pulmonary nodules[J]. Technology Cancer Research & treatment, 2022. DOI:10.1177/15330338221118718. PMID: 35930585; PMCID: PMC9358554.
[10] PENG T F, REN T, WANG H S, et al. Diagnostic value of rapid on-site evaluation for CT-guided percutaneous fine needle aspiration in the diagnosis of pulmonary occupying lesions[J]. Biomed Research International, 2020, 2020: 9842768. DOI: 10.1155/2020/9842768.
[11] SANTAMBROGIO L, NOSOTTI M, BELLAVITI N, et al. CT-guided fine-needle aspiration cytology of solitary pulmonary nodules: A prospective, randomized study of immediate cytologic evaluation[J]. Chest, 1997, 112(2): 423−425. doi: 10.1378/chest.112.2.423
[12] YIMINNIYAZE R, ZHANG X, ZHANG Y, et al. Diagnostic efficiency and safety of rapid on-site evaluation combined with CT-guided transthoracic core needle biopsy in suspected lung cancer patients[J]. Cytopathology, 33(4): 439-444. DOI:10.1111/cyt.13123. PMID: 35362154; PMCID: PMC9324149.
[13] TSUKADA H, SATOU T, IWASHIMA A, et al. Diagnostic accuracy of CT-guided automated needle biopsy of lung nodules[J]. American Journal of Roentgenology, 2000, 175(1): 239−243. doi: 10.2214/ajr.175.1.1750239
[14] TRISOLINI R, CANCELLIERI A, TINELLI C, et al. Randomized trial of endobronchial ultrasound-guided transbronchial needle aspiration with and without rapid on-site evaluation for lung cancer genotyping[J]. Chest, 2015, 148(6): 1430−1437. doi: 10.1378/chest.15-0583
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