经支气管冷冻活检在外周肺部病变的诊断价值和安全性:一项meta分析

Diagnostic value and safety of transbronchial cryobiopsy in peripheral lung lesions:A meta-analysis

目的探讨经支气管冷冻肺活检(TBCB)与经支气管钳夹活检(TBFB)对肺外周病变的诊断价值和安全性。方法以"肺外周病变""肺外周结节""孤立性肺结节""经支气管冷冻活检"为检索词在CNKI、PubMed、Cochrane Library、Embase和万方医学网数据库检索对TBCB的相关研究,检索时间截至2022年9月10日,筛选出符合条件的研究进行质量评估,并对最终纳入的文章进行亚组分析和敏感性分析,结局指标是诊断率、大出血及气胸发生率,采用STATA16.0版本统计软件进行统计分析。结果共纳入13篇研究,816例患者。其中8篇双臂研究包括618例患者,TBCB组280例,TBFB组338例,5篇自身对照实验共198例。分析结果显示TBCB组取材面积是TBFB组面积的2~9倍,TBCB与TBFB相比能提高肺外周病变的诊断率,两者对肺外周病变诊断率差异有统计学意义(logOR=0.48,95%CI:0.03~0.93,I^(2)=54.11%)。且TBCB不会造成较高的出血风险(logOR=0.71,95%CI:-0.07~1.50,I^(2)=62.74%)。同时,TBCB和TBFB2组间气胸发生率差异无统计学意义(logOR=-0.07,95%CI:-0.75~0.61)。结论TBCB在诊断率和取材面积方面优于TBFB,且不会增加出血及气胸的风险。

Objective To investigate the diagnostic value and safety of transbronchial cryobiopsy(TBCB)versus transbronchial forceps biopsy(TBFB)in peripheral lung lesions.Methods Relevant literatures on TBCB published before September 10,2022 were searched in the online databases of CNKI,PubMed,Cochrane Library,Embase and Wanfang using the key words of"peripheral lung lesions""lung peripheral nodules","isolated lung nodules"and"transbronchial frozen biopsy".Eligible studies were selected for quality assessment,and subgroup analysis and sensitivity analysis of the final included articles were performed.The outcome indicators were the diagnostic rate,the incidence of major bleeding and pneumothorax,which were statistically analyzed using the STATA version 16.0.Results A total of 13 eligible studies involving 816 patients were included.Among them,8 two-arm studies included 618 patients,with 280 in the TBCB group,and 338 in the TBFB group.A total of 198 patients were from the 5 self-control trials.The analysis results showed that the material area of the TBCB group was 2-9 times that of the TBFB group.Compared with TBFB,TBCB could improve the diagnostic rate of the lung peripheral lesions.A significant difference was detected in the diagnostic rate of the lung peripheral lesions between TBCB group and TBFB group(logOR=0.48,95%CI(0.03-0.93),I^(2)=54.11%).And TBCB did not pose a higher risk of bleeding than that of TBFB(logOR=0.71,95%CI(-0.07-1.50),I^(2)=62.74%).There was no significant difference in the pneumothorax incidence between the two groups(logOR=-0.07,95%CI(-0.75-0.61)).Conclusions TBCB is better than those of TBFB in the diagnostic rate and material area,and it does not increase the risk of bleeding and pneumothorax.