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ABSTRACT
Background
Real-time thoracic ultrasound-guided pleural biopsy (TUSPB) is an important diagnostic method for pleural diseases. Traditional two-dimensional thoracic ultrasound, as well as newly developed contrast-enhanced ultrasound (CEUS) and ultrasound elastography (UE), are all used as guidance tools for pleural biopsies. Herein, we aimed to determine the diagnostic yield of real-time TUSPB for pleural diseases to better inform the decision-making process.
Methods
A literature search of the MEDLINE/PubMed, Embase, and Cochrane Library databases was performed up to June 2023. A binary random-effects model was applied to determine the pooled diagnostic yield.
Results
Fifteen studies comprising 1553 patients with pleural diseases were included and analyzed. The overall diagnostic yield of TUSPB for pleural diseases was 85.58% (95% confidence interval [CI]: 81.57–89.58%). The sensitivity was 77.56% for pleural malignancy and 80.13% for tuberculous pleurisy. The sub-analysis result revealed that CEUS-guided pleural biopsy provided a pooled diagnostic yield of 98.24%, which was higher than that of conventional TUSPB (78.97%; p < 0.01). The overall proportion of adverse events for TUSPB was 6.68% (95% CI: 5.31–8.04%).
Conclusion
Conventional TUSPB has good pooled diagnostic yields and high safety. CEUS and UE are promising guidance tools for pleural biopsy with the potential to increase diagnostic yield.
Abbreviations
| TUSPB | = | thoracic ultrasound-guided pleural biopsy |
| CEUS | = | contrast-enhanced ultrasound |
| CI | = | confidence interval |
| CT | = | computed tomography |
| UE | = | ultrasound elastography |
| UEPB | = | UE-guided pleural biopsy |
| CRS | = | composite reference standard |
| PRISMA | = | Preferred Reporting Items for Systematic Reviews and Meta-Analyses |
| QUADAS-2 | = | Quality Assessment of Diagnostic Accuracy Studies |
Author contributions
G Hou contributed to conception and design of the study. Q Zhang, M Deng and Y Lu screened the articles. Q Zhang and M Deng extracted the data. Q Z and X Li performed the statistical analysis and interpretation. Q Zhang wrote the first draft of the manuscript. G Hou, Q Zhang, M Deng, Y Lu, and X Li revised it critically for intellectual content. All authors approve the version to be published and agree to be accountable for all aspects of the work.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
A reviewer on this manuscript has disclosed that they were the first author on one of the studies this SR/Meta-analysis has included in this review. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.
Supplementary materials
Supplemental data for this article can be accessed online at https://doi.org/10.1080/17476348.2023.2266377