Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pulmonary Medicine
Published in: BMC Pulmonary Medicine 1/2018

Open Access 01-12-2018 | Research article

Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review

Authors: Chuan-Jiang Deng, Fu-Qiang Dai, Kai Qian, Qun-You Tan, Ru-Wen Wang, Bo Deng, Jing-Hai Zhou

Published in: BMC Pulmonary Medicine | Issue 1/2018

Login to get access

Abstract

Background

Convenient approaches for accurate biopsy are extremely important to the diagnosis of lung cancer. We aimed to systematically review the clinical updates and development trends of approaches for biopsy, i.e., CT-guided PTNB (Percutaneous Transthoracic Needle Biopsy), ENB (Electromagnetic Navigation Bronchoscopy), EBUS-TBNA (Endobroncheal Ultrasonography-Transbronchial Needle Aspiration), mediastinoscopy and CTC (Circulating Tumor Cell).

Methods

Medline and manual searches were performed. We identified the relevant studies, assessed study eligibility, evaluated methodological quality, and summarized diagnostic yields and complications regarding CT-guided PTNB (22 citations), ENB(31 citations), EBUS-TBNA(66 citations), Mediastinoscopy(15 citations) and CTC (19 citations), respectively.

Results

The overall sensitivity and specificity of CT-guided PTNB were reported to be 92.52% ± 3.14% and 97.98% ± 3.28%, respectively. The top two complications of CT-guided PTNB was pneumothorax (946/4170:22.69%) and hemorrhage (138/1949:7.08%). The detection rate of lung cancer by ENB increased gradually to 79.79% ± 15.34% with pneumothorax as the top one complication (86/1648:5.2%). Detection rate of EBUS-TBNA was 86.06% ± 9.70% with the top three complications, i.e., hemorrhage (53/8662:0.61%), pneumothorax (46/12432:0.37%) and infection (34/11250:0.30%). The detection rate of mediastinoscopy gradually increased to 92.77% ± 3.99% with .hoarseness as the refractory complication (4/2137:0.19%). Sensitivity and specificity of CTCs detection by using PCR (Polymerase Chain Reaction) were reported to be 78.81% ± 14.72% and 90.88% ± 0.53%, respectively.

Conclusion

The biopsy approaches should be chosen considering a variety of location and situation of lesions. CT-guided PTNB is effective to reach lung parenchyma, however, diagnostic accuracy and incidence of complications may be impacted by lesion size or needle path length. ENB has an advantage for biopsy of smaller and deeper lesions in lung parenchyma. ENB plus EBUS imaging can further improve the detection rate of lesion in lung parenchyma. EBUS-TBNA is relatively safer and mediastinoscopy provides more tissue acquisition and better diagnostic yield of 4R and 7th lymph node. CTC detection can be considered for adjuvant diagnosis.
Literature
1.
2.
Geraghty PR, et al. CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology. 2003;229(2):475–81.CrossRefPubMed
3.
Lee SM, et al. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients. Radiology. 2014;271(1):291–300.CrossRefPubMed
4.
Ohno Y, et al. Transthoracic CT-guided biopsy with multiplanar reconstruction image improves diagnostic accuracy of solitary pulmonary nodules. Eur J Radiol. 2004;51(2):160–8.CrossRefPubMed
5.
6.
Gorgulu FF, et al. Computed tomography-guided transthoracic biopsy: factors influencing diagnostic and complication rates. J Int Med Res. 2017;45(2):808–15.CrossRefPubMedPubMedCentral
7.
Otto S, et al. Predictors of technical success and rate of complications of image-guided percutaneous transthoracic lung needle biopsy of pulmonary tumors. PLoS One. 2015;10(4):e0124947.CrossRefPubMedPubMedCentral
8.
Sachdeva M, et al. Complications and yield of computed tomography-guided transthoracic Core needle biopsy of lung nodules at a high-volume academic Center in an Endemic Coccidioidomycosis Area. Lung. 2016;194(3):379–85.CrossRefPubMed
9.
Jaconi M, et al. C-arm cone-beam CT-guided transthoracic lung core needle biopsy as a standard diagnostic tool: an observational study. Medicine (Baltimore). 2015;94(12):e698.CrossRef
10.
Mukherjee S, Chacey M. Diagnostic yield of electromagnetic navigation bronchoscopy using a curved-tip catheter to aid in the diagnosis of pulmonary lesions. J Bronchology Interv Pulmonol. 2017;24(1):35–9.CrossRefPubMed
11.
Ozgul G, et al. Efficacy and safety of electromagnetic navigation bronchoscopy with or without radial endobronchial ultrasound for peripheral lung lesions. Endosc Ultrasound. 2016;5(3):189–95.CrossRefPubMedPubMedCentral
12.
Mahajan AK, et al. Electromagnetic navigational bronchoscopy: an effective and safe approach to diagnose peripheral lung lesions unreachable by conventional bronchoscopy in high-risk patients. J Bronchology Interv Pulmonol. 2011;18(2):133–7.CrossRefPubMed
13.
Schroeder C, Hejal R, Linden PA. Coil spring fiducial markers placed safely using navigation bronchoscopy in inoperable patients allows accurate delivery of CyberKnife stereotactic radiosurgery. J Thorac Cardiovasc Surg. 2010;140(5):1137–42.CrossRefPubMed
14.
Eberhardt R, et al. Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions. Chest. 2007;131(6):1800–5.CrossRefPubMed
15.
Pearlstein DP, et al. Electromagnetic navigation bronchoscopy performed by thoracic surgeons: one center’s early success. Ann Thorac Surg. 2012;93(3):944–9. discussion 949-50CrossRefPubMed
16.
Towe CW, et al. Severe chronic obstructive pulmonary disease is not associated with complications after navigational bronchoscopy procedures. Ann Thorac Surg. 2017;104(1):290–5.CrossRefPubMed
17.
Makris D, et al. Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions. Eur Respir J. 2007;29(6):1187–92.CrossRefPubMed
18.
Bertoletti L, et al. Accuracy and feasibility of electromagnetic navigated bronchoscopy under nitrous oxide sedation for pulmonary peripheral opacities: an outpatient study. Respiration. 2009;78(3):293–300.CrossRefPubMed
19.
Chee A, et al. Diagnostic utility of peripheral endobronchial ultrasound with electromagnetic navigation bronchoscopy in peripheral lung nodules. Respirology. 2013;18(5):784–9.CrossRefPubMed
20.
Eberhardt R, et al. Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial. Am J Respir Crit Care Med. 2007;176(1):36–41.CrossRefPubMed
21.
Bowling MR, et al. The effect of general anesthesia versus intravenous sedation on diagnostic yield and success in electromagnetic navigation bronchoscopy. J Bronchology Interv Pulmonol. 2015;22(1):5–13.CrossRefPubMed
22.
Jensen KW, et al. Multicenter experience with electromagnetic navigation bronchoscopy for the diagnosis of pulmonary nodules. J Bronchology Interv Pulmonol. 2012;19(3):195–9.CrossRefPubMed
23.
Eberhardt R, et al. Comparison of suction catheter versus forceps biopsy for sampling of solitary pulmonary nodules guided by electromagnetic navigational bronchoscopy. Respiration. 2010;79(1):54–60.CrossRefPubMed
24.
Dale CR, et al. Navigational bronchoscopy with biopsy versus computed tomography-guided biopsy for the diagnosis of a solitary pulmonary nodule: a cost-consequences analysis. J Bronchology Interv Pulmonol. 2012;19(4):294–303.CrossRefPubMedPubMedCentral
25.
Nabavizadeh N, et al. Electromagnetic navigational bronchoscopy-guided fiducial markers for lung stereotactic body radiation therapy: analysis of safety, feasibility, and interfraction stability. J Bronchology Interv Pulmonol. 2014;21(2):123–30.CrossRefPubMed
26.
Eberhardt R, et al. LungPoint--a new approach to peripheral lesions. J Thorac Oncol. 2010;5(10):1559–63.CrossRefPubMed
27.
28.
29.
Lamprecht B, et al. Electromagnetic navigation bronchoscopy (ENB): increasing diagnostic yield. Respir Med. 2012;106(5):710–5.CrossRefPubMed
30.
Karnak D, et al. Rapid on-site evaluation and low registration error enhance the success of electromagnetic navigation bronchoscopy. Ann Thorac Med. 2013;8(1):28–32.CrossRefPubMedPubMedCentral
31.
Gex G, et al. Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: a systematic review and meta-analysis. Respiration. 2014;87(2):165–76.CrossRefPubMed
32.
Asano F, et al. Complications associated with endobronchial ultrasound-guided transbronchial needle aspiration: a nationwide survey by the Japan Society for Respiratory Endoscopy. Respir Res. 2013;14:50.CrossRefPubMedPubMedCentral
33.
Eapen GA, et al. Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE registry. Chest. 2013;143(4):1044–53.CrossRefPubMed
34.
Hayama M, et al. Complications with endobronchial ultrasound with a guide sheath for the diagnosis of peripheral pulmonary lesions. Respiration. 2015;90(2):129–35.CrossRefPubMed
35.
Steinfort DP, et al. Pulmonologist-performed per-esophageal needle aspiration of parenchymal lung lesions using an EBUS bronchoscope: diagnostic utility and safety. J Bronchology Interv Pulmonol. 2017;24(2):117–24.CrossRefPubMed
36.
Chen CH, et al. Endobronchial ultrasound changed the world of lung Cancer patients: a 11-year institutional experience. PLoS One. 2015;10(11):e0142336.CrossRefPubMedPubMedCentral
37.
Sayar A, et al. The incidence of hoarseness after mediastinoscopy and outcome of video-assisted versus conventional mediastinoscopy in lung cancer staging. Acta Chir Belg. 2016;116(1):23–9.CrossRefPubMed
38.
Turna A, et al. Video-assisted mediastinoscopic lymphadenectomy is associated with better survival than mediastinoscopy in patients with resected non-small cell lung cancer. J Thorac Cardiovasc Surg. 2013;146(4):774–80.CrossRefPubMed
39.
Chauhan A, et al. Cervical mediastinoscopy: re-evaluation of an old technique in era of new imaging technology. Indian J Chest Dis Allied Sci. 2012;54(3):169–73.PubMed
40.
Lardinois D, et al. Postinduction video-mediastinoscopy is as accurate and safe as video-mediastinoscopy in patients without pretreatment for potentially operable non-small cell lung cancer. Ann Thorac Surg. 2003;75(4):1102–6.CrossRefPubMed
41.
Hujala KT, Sipila JI, Grenman R. Mediastinoscopy--its role and value today in the differential diagnosis of mediastinal pathology. Acta Oncol. 2001;40(1):79–82.CrossRefPubMed
42.
43.
Cho JH, et al. A comparative analysis of video-assisted mediastinoscopy and conventional mediastinoscopy. Ann Thorac Surg. 2011;92(3):1007–11.CrossRefPubMed
44.
Anraku M, et al. Video-assisted mediastinoscopy compared with conventional mediastinoscopy: are we doing better? Ann Thorac Surg. 2010;89(5):1577–81.CrossRefPubMed
45.
Leschber G, et al. Does video-mediastinoscopy improve the results of conventional mediastinoscopy? Eur J Cardiothorac Surg. 2008;33(2):289–93.CrossRefPubMed
46.
Hammoud ZT, et al. The current role of mediastinoscopy in the evaluation of thoracic disease. J Thorac Cardiovasc Surg. 1999;118(5):894–9.CrossRefPubMed
47.
Bayarri-Lara C, et al. Circulating tumor cells identify early recurrence in patients with non-small cell lung Cancer undergoing radical resection. PLoS One. 2016;11(2):e0148659.CrossRefPubMedPubMedCentral
48.
Sawabata N, et al. Perioperative circulating tumor cells in surgical patients with non-small cell lung cancer: does surgical manipulation dislodge cancer cells thus allowing them to pass into the peripheral blood? Surg Today. 2016;46(12):1402–9.CrossRefPubMed
49.
Zhang W, et al. Tumor-selective replication herpes simplex virus-based technology significantly improves clinical detection and prognostication of viable circulating tumor cells. Oncotarget. 2016;7(26):39768–83.PubMedPubMedCentral
50.
Chen X, et al. Combination of circulating tumor cells with serum carcinoembryonic antigen enhances clinical prediction of non-small cell lung cancer. PLoS One. 2015;10(5):e0126276.CrossRefPubMedPubMedCentral
51.
Fiorelli A, et al. Circulating tumor cells in diagnosing lung Cancer: clinical and morphologic analysis. Ann Thorac Surg. 2015;99(6):1899–905.CrossRefPubMed
52.
Nair VS, et al. An observational study of circulating tumor cells and (18)F-FDG PET uptake in patients with treatment-naive non-small cell lung cancer. PLoS One. 2013;8(7):e67733.CrossRefPubMedPubMedCentral
53.
Hofman V, et al. Preoperative circulating tumor cell detection using the isolation by size of epithelial tumor cell method for patients with lung cancer is a new prognostic biomarker. Clin Cancer Res. 2011;17(4):827–35.CrossRefPubMed
54.
Funaki S, et al. Novel approach for detection of isolated tumor cells in pulmonary vein using negative selection method: morphological classification and clinical implications. Eur J Cardiothorac Surg. 2011;40(2):322–7.PubMed
55.
Franco R, et al. CXCL12-binding receptors expression in non-small cell lung cancer relates to tumoral microvascular density and CXCR4 positive circulating tumoral cells in lung draining venous blood. Eur J Cardiothorac Surg. 2012;41(2):368–75.CrossRefPubMed
56.
Hofman V, et al. Detection of circulating tumor cells as a prognostic factor in patients undergoing radical surgery for non-small-cell lung carcinoma: comparison of the efficacy of the CellSearch Assay and the isolation by size of epithelial tumor cell method. Int J Cancer. 2011;129(7):1651–60.CrossRefPubMed
57.
Yoon SO, et al. TTF-1 mRNA-positive circulating tumor cells in the peripheral blood predict poor prognosis in surgically resected non-small cell lung cancer patients. Lung Cancer. 2011;71(2):209–16.CrossRefPubMed
58.
Tanaka F, et al. Circulating tumor cell as a diagnostic marker in primary lung cancer. Clin Cancer Res. 2009;15(22):6980–6.CrossRefPubMed
59.
Liu L, et al. Detection of circulating cancer cells in lung cancer patients with a panel of marker genes. Biochem Biophys Res Commun. 2008;372(4):756–60.CrossRefPubMed
60.
Yie SM, et al. Clinical significance of detecting survivin-expressing circulating cancer cells in patients with non-small cell lung cancer. Lung Cancer. 2009;63(2):284–90.CrossRefPubMed
61.
Sawabata N, et al. Circulating tumor cells in peripheral blood caused by surgical manipulation of non-small-cell lung cancer: pilot study using an immunocytology method. Gen Thorac Cardiovasc Surg. 2007;55(5):189–92.CrossRefPubMed
62.
Sheu CC, et al. Development of a membrane array-based multimarker assay for detection of circulating cancer cells in patients with non-small cell lung cancer. Int J Cancer. 2006;119(6):1419–26.CrossRefPubMed
63.
Rolle A, et al. Increase in number of circulating disseminated epithelial cells after surgery for non-small cell lung cancer monitored by MAINTRAC(R) is a predictor for relapse: a preliminary report. World J Surg Oncol. 2005;3(1):18.CrossRefPubMedPubMedCentral
64.
Yamashita J, et al. Preoperative evidence of circulating tumor cells by means of reverse transcriptase-polymerase chain reaction for carcinoembryonic antigen messenger RNA is an independent predictor of survival in non-small cell lung cancer: a prospective study. J Thorac Cardiovasc Surg. 2002;124(2):299–305.CrossRefPubMed
65.
Yamashita JI, et al. Detection of circulating tumor cells in patients with non-small cell lung cancer undergoing lobectomy by video-assisted thoracic surgery: a potential hazard for intraoperative hematogenous tumor cell dissemination. J Thorac Cardiovasc Surg. 2000;119(5):899–905.CrossRefPubMed
66.
Brownback KR, et al. Electromagnetic navigational bronchoscopy in the diagnosis of lung lesions. J Bronchology Interv Pulmonol. 2012;19(2):91–7.CrossRefPubMed
67.
Cerfolio RJ, et al. The true false negative rates of esophageal and endobronchial ultrasound in the staging of mediastinal lymph nodes in patients with non-small cell lung cancer. Ann Thorac Surg. 2010;90(2):427–34.CrossRefPubMed
Metadata
Title
Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review
Authors
Chuan-Jiang Deng
Fu-Qiang Dai
Kai Qian
Qun-You Tan
Ru-Wen Wang
Bo Deng
Jing-Hai Zhou
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2018
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-018-0713-6

Other articles of this Issue 1/2018

BMC Pulmonary Medicine 1/2018 Go to the issue

Research article

Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease

Research article

Relationship between pulmonary function and peripheral vascular function in older Chinese: Guangzhou biobank cohort study-CVD

Research article

Epidemiology of pulmonary disease due to nontuberculous mycobacteria in Southern China, 2013–2016

Research article

National survey: current prevalence and characteristics of home mechanical ventilation in Hungary

Research article

Secondary pulmonary alveolar proteinosis: a single-center retrospective study (a case series and literature review)

Research article

The relationship between high-dose corticosteroid treatment and mortality in acute respiratory distress syndrome: a retrospective and observational study using a nationwide administrative database in Japan
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits