Diagnostic yield and safety of image-guided pleural biopsy: a systematic review and meta-analysis

Background: The diagnostic yield (DY) and safety of computed tomography(CT)-guided and thoracic ultrasound(TUS)-guided biopsy of pleural lesions have been investigated in a number of studies, but no synthesis of data has been performed
Aims and Objectives: We aim to provide the first systematic review and meta-analysis on CT- versus TUS-guided biopsy in the diagnosis of pleural lesions.
Methods: We searched Medline and Embase for all studies reporting outcomes of interest published up to April 2018. Summary estimates were derived using the random-effects model. Cumulative meta-analysis assessed the influence of increasing adoption of the procedures over time
Results: Thirty original studies were included. The pooled DYs of the two procedures were high and differed less than 10%, being 84% for TUS-guided biopsy and 93% for CT-guided biopsy. Safety was good for both the techniques, with an adverse event rate of 7% and 3% for CT- and TUS-guided biopsy, respectively. DY of the ultrasound technique significantly improved over time, while no time-effect was observed for CT-guided biopsy
Conclusions: CT- and TUS-guided pleural biopsy are both sensitive techniques without meaningful differences in DYs and safety. Considering that TUS is non-ionising and easily performed at the bedside, this data suggest that TUS should be the preferred approach in presence of adequate skills, which challenges the current guidelines