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      Robotic‐assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta‐analysis

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          Abstract

          Robotic‐assisted bronchoscopy (RAB) is a newly developed bronchoscopic technique for the diagnosis of peripheral pulmonary lesions (PPLs). The objective of this meta‐analysis was to analyze the diagnostic yield and safety of RAB in patients with PPLs. Five databases (PubMed, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov) were searched from inception to April 2023. Two independent investigators screened retrieved articles, extracted data, and assessed the study quality. The pooled diagnostic yield and complication rate were estimated. Subgroup analysis was used to explore potential sources of heterogeneity. Publication bias was assessed using funnel plots and the Egger test. Sensitivity analysis was also conducted to assess the robustness of the synthesized results. A total of 725 lesions from 10 studies were included in this meta‐analysis. No publication bias was found. Overall, RAB had a pooled diagnostic yield of 80.4% (95% CI: 75.7%–85.1%). Lesion size of >30 mm, presence of a bronchus sign, and a concentric radial endobronchial ultrasound view were associated with a statistically significantly higher diagnostic yield. Heterogeneity exploration showed that studies using cryoprobes reported better yields than those without cryoprobes (90.0%, 95% CI: 83.2%–94.7% vs. 79.0%, 95% CI: 75.8%–82.2%, p < 0.01). The pooled complication rate was 3.0% (95% CI: 1.6%–4.4%). In conclusion, RAB is an effective and safe technique for PPLs diagnosis. Further high‐quality prospective studies still need to be conducted.

          Abstract

          We performed a meta‐analysis to analyze the diagnostic yield and safety of robotic‐assisted bronchoscopy in patients with peripheral pulmonary lesions. A total of 725 lesions from 10 studies were included. The pooled diagnostic yield was 80.4% (95% CI: 75.7%–85.1%), and the pooled complication rate was 3.0% (95% CI: 1.6%–4.4%). Lesion size of >30 mm, presence of a bronchus sign, and a concentric radial endobronchial ultrasound view were associated with a statistically significantly higher diagnostic yield.

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          QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies.

          Penny F Whiting, Anne W S Rutjes, Marie E Westwood … (2011)
          In 2003, the QUADAS tool for systematic reviews of diagnostic accuracy studies was developed. Experience, anecdotal reports, and feedback suggested areas for improvement; therefore, QUADAS-2 was developed. This tool comprises 4 domains: patient selection, index test, reference standard, and flow and timing. Each domain is assessed in terms of risk of bias, and the first 3 domains are also assessed in terms of concerns regarding applicability. Signalling questions are included to help judge risk of bias. The QUADAS-2 tool is applied in 4 phases: summarize the review question, tailor the tool and produce review-specific guidance, construct a flow diagram for the primary study, and judge bias and applicability. This tool will allow for more transparent rating of bias and applicability of primary diagnostic accuracy studies.
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            Reduced lung-cancer mortality with low-dose computed tomographic screening.

            (2011)
            The aggressive and heterogeneous nature of lung cancer has thwarted efforts to reduce mortality from this cancer through the use of screening. The advent of low-dose helical computed tomography (CT) altered the landscape of lung-cancer screening, with studies indicating that low-dose CT detects many tumors at early stages. The National Lung Screening Trial (NLST) was conducted to determine whether screening with low-dose CT could reduce mortality from lung cancer. From August 2002 through April 2004, we enrolled 53,454 persons at high risk for lung cancer at 33 U.S. medical centers. Participants were randomly assigned to undergo three annual screenings with either low-dose CT (26,722 participants) or single-view posteroanterior chest radiography (26,732). Data were collected on cases of lung cancer and deaths from lung cancer that occurred through December 31, 2009. The rate of adherence to screening was more than 90%. The rate of positive screening tests was 24.2% with low-dose CT and 6.9% with radiography over all three rounds. A total of 96.4% of the positive screening results in the low-dose CT group and 94.5% in the radiography group were false positive results. The incidence of lung cancer was 645 cases per 100,000 person-years (1060 cancers) in the low-dose CT group, as compared with 572 cases per 100,000 person-years (941 cancers) in the radiography group (rate ratio, 1.13; 95% confidence interval [CI], 1.03 to 1.23). There were 247 deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309 deaths per 100,000 person-years in the radiography group, representing a relative reduction in mortality from lung cancer with low-dose CT screening of 20.0% (95% CI, 6.8 to 26.7; P=0.004). The rate of death from any cause was reduced in the low-dose CT group, as compared with the radiography group, by 6.7% (95% CI, 1.2 to 13.6; P=0.02). Screening with the use of low-dose CT reduces mortality from lung cancer. (Funded by the National Cancer Institute; National Lung Screening Trial ClinicalTrials.gov number, NCT00047385.).
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              STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies

              Patrick Bossuyt, Johannes Reitsma, David Bruns … (2015)
              Incomplete reporting has been identified as a major source of avoidable waste in biomedical research. Essential information is often not provided in study reports, impeding the identification, critical appraisal, and replication of studies. To improve the quality of reporting of diagnostic accuracy studies, the Standards for Reporting Diagnostic Accuracy (STARD) statement was developed. Here we present STARD 2015, an updated list of 30 essential items that should be included in every report of a diagnostic accuracy study. This update incorporates recent evidence about sources of bias and variability in diagnostic accuracy and is intended to facilitate the use of STARD. As such, STARD 2015 may help to improve completeness and transparency in reporting of diagnostic accuracy studies.
              Article 0 comments Cited 868 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Felix J. F. Herth: Felix.Herth@med.uni-heidelberg.de
                Jiayuan Sun:
                ORCID: https://orcid.org/0000-0003-3158-3256
                xkyyjysun@163.com
                Journal
                Journal ID (nlm-ta): Thorac Cancer
                Journal ID (iso-abbrev): Thorac Cancer
                Journal ID (doi): 10.1111/(ISSN)1759-7714
                Journal ID (publisher-id): TCA
                Title: Thoracic Cancer
                Publisher: John Wiley & Sons Australia, Ltd (Melbourne )
                ISSN (Print): 1759-7706
                ISSN (Electronic): 1759-7714
                Publication date (Electronic): 29 January 2024
                Publication date Collection: March 2024
                Volume: 15
                Issue: 7 ( doiID: 10.1111/tca.v15.7 )
                Pages: 505-512
                Affiliations
                [ 1 ] Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
                [ 2 ] Shanghai Engineering Research Center of Respiratory Endoscopy Shanghai China
                [ 3 ] Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg Heidelberg Germany
                Author notes
                [*] [* ] Correspondence

                Jiayuan Sun, Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.

                Email: xkyyjysun@ 123456163.com

                Felix J. F. Herth, Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Röntgenstrasse 1, DE–69126 Heidelberg, Germany.

                Email: Felix.Herth@ 123456med.uni-heidelberg.de

                Author information
                https://orcid.org/0000-0003-3158-3256
                Article
                Publisher ID: TCA15229
                DOI: 10.1111/1759-7714.15229
                PMC ID: 10912532
                PubMed ID: 38286133
                SO-VID: 98e3e8ba-ec9e-4d28-bdaf-24ec0e57890b
                Copyright © © 2024 The Authors. Thoracic Cancer published by John Wiley & Sons Australia, Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date revision received : 10 January 2024
                Date received : 16 November 2023
                Date accepted : 13 January 2024
                Page count
                Figures: 4, Tables: 3, Pages: 8, Words: 5715
                Funding
                Funded by: Joint Clinical Research Center of Institute of Medical Robotics‐Chest Hospital, Shanghai Jiao Tong University
                Award ID: IMR‐XKH202102
                Funded by: Science and Technology Commission of Shanghai Municipality , doi 10.13039/501100003399;
                Award ID: 20S31905200
                Award ID: 21XD1434400
                Categories
                Subject: Review
                Subject: Review
                Custom metadata
                source-schema-version-number 2.0
                cover-date March 2024
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.9 mode:remove_FC converted:05.03.2024

                Keywords: bronchoscopy,lung cancer,meta‐analysis,peripheral pulmonary lesion,robotic‐assisted bronchoscopy
                Data availability:
                Keywords: bronchoscopy, lung cancer, meta‐analysis, peripheral pulmonary lesion, robotic‐assisted bronchoscopy

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