Minimally Invasive Interventions for Pulmonary Nodule Biopsy - Systematic Review

Background: In the diagnosis of lung cancer, a biopsy should be recommended to confirm malignancy. This study was designed to compare diagnostic yield and safety of different techniques used for pulmonary nodule biopsies. Methods: Systematic review of randomized controlled trials that evaluated minimally invasive methods for lung nodule biopsies, comparing tomography-guided percutaneous biopsy (PERCUT), and transbronchial biopsies guided by fluoroscopy (FLUOR), endobronchial ultrasound with radial probe (EBUSR) or electromagnetic navigation (NAVIG). The certainty of evidence was assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Findings: Seven RCTs (randomized controlled trials) were included (total of 913 participants, 39·1% female, mean age 59·28 years). All RCTs were classified as high risk of bias. The certainty of evidence was considered low or very low according to GRADE system. For PERCUT versus FLUOR, PERCUT versus EBUSR, FLUOR versus NAVIG, and EBUSR versus NAVIG comparisons, there was no difference regarding diagnostic yield and need of approach by another technique. There were similar findings for the safety outcomes, however in the comparison between PERCUT versus EBUSR, there was greater risk of non-serious adverse events with PERCUT. In the comparison between FLUOR versus EBUSR, there was clinically relevant benefit in favor of EBUSR in diagnostic yield, need for another technique approach and risk of serious adverse events. Interpretation: In this review, there was no significant difference in the comparison between the diagnostic yield and safety in most of the interventions. There is insufficient current evidence to recommend one method over another, and therefore the potential risks and benefits must be presented to patients for a shared decision on the method. Clinical Trial Registration Details: The protocol was prospectively registered in the PROSPERO database (CRD42018092367, available from https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=92367). Funding Information: None. Declaration of Interests: None.