支气管镜冷冻活检与CT引导活检诊断肺外周结节Meta分析

Meta-Analysis of Transbronchial Cryobiopsy and CT-Guided Percutaneous Needle Biopsy in the Diagnosis of Peripheral Pulmonary Nodules

摘要: 目的：系统评价支气管镜冷冻活检与CT引导经皮穿刺活检诊断肺外周结节的有效性及安全性。方法：检索CNKI、PubMed数据库，收集至2021年4月关于支气管镜冷冻活检(transbronchial cryobiopsy, TBCB)与CT引导经皮穿刺活检(CT-guided percutaneous needle biopsy, CT-PNB)诊断肺外周结节的临床研究。按照纳入与排除标准筛选文献、提取资料、质量评价，采用STATA软件进行Meta分析。结果：TBCB纳入文献10篇，合计患者504例。CT-PNB纳入文献9篇，合计患者1028例。Meta分析显示，CT-PNB (随机效应模型，敏感度：94.6%，95% CI: 92~96，特异度：100%，P < 0.10，I² > 50%)敏感度、特异度高于TBCB (随机对照模型，敏感度：89.77%，95% CI: 80~90，特异度99%，P < 0.10，I² > 50%)。TBCB诊断肺外周结节并发症发生率(35.91%)高于CT-PNB (35.89%)，差异无统计学意义(X² < 3.84, P > 0.05)。TBCB出血发生率明显高于CT-PNB (TBCB: 32.9%, CT-PNB: 6.1%, X² > 3.84, P < 0.05)；气胸发生率TBCB明显低于CT-PNB，差异有统计学意义(TBCB: 2.98%, CT-PNB: 24.4%, X² >3.84, P < 0.05)。结论：CT-PNB比TBCB诊断肺外周结节敏感度及特异度更高，气胸发生率高，出血发生率低。

Abstract: Objective: the objective is to systematically evaluate the effectiveness and safety of transbronchial cryobiopsy and CT-guided percutaneous needle biopsy for peripheral pulmonary nodules. Methods: Search CNKI, PubMed, and collect studies on transbronchial cryobiopsy and CT-guided percutaneous needle biopsy for peripheral pulmonary nodules from the establishment of the database to April, 2021. According to the inclusion and exclusion criteria, extracting the data and evaluating the quality of the literature, STATA software was used for Meta-analysis. Results: A total of 10 studies were included, with a total of 504 patients in transbronchial cryobiopsy for peripheral pulmonary nodules. A total of 9 studies were included, with a total of 1028 patients in CT-guided percutaneous needle biopsy for peripheral pulmonary nodules. Meta-analysis showed that the total effective rate of CT-guided percutaneous needle biopsy (Randomized controlled model, sensitivity: 94.6%, 95% CI: 92~96, specificity: 100%, P < 0.10, I² > 50%) is better than transbronchial cryobiopsy (Randomized controlled model, sensitivity: 89.77%, 95% CI: 80~90, specificity: 99%, P < 0.10, I² > 50%) for peripheral pulmonary nodules. The incidence of complications in transbronchial cryobiopsy (35.91%) is higher than that in CT-guided percutaneous needle biopsy (35.89%), there is no significant difference (X² < 3.84, P > 0.05). The incidence of bleeding in transbronchial cryobiopsy is significantly higher than that in CT-guided percutaneous needle biopsy (TBCB: 32.9%, CT-PNB: 6.1%, X² > 3.84, P < 0.05). The incidence of pneumothorax in transbronchial cryobiopsy is significantly lower than that in CT-guided percutaneous needle biopsy (TBCB: 2.98%, CT-PNB: 24.4%, X² > 3.84, P < 0.05), there are significant differences. Conclusion: The sensitivity and specificity of CT-guided percutaneous needle biopsy for peripheral pulmonary nodules are better than transbronchial cryobiopsy. Pneumothorax is more common in CT-guided percutaneous needle biopsy, and bleeding is more common in transbronchial cryobiopsy.