Usefulness of computed tomography-guided puncture biopsy coupled with rapid on‑site evaluation for diagnosis of pulmonary lesions: a systematic review and meta‑analysis.

Introduction: Accurate identification of lung lesions during lung biopsy (LB) surgery can be achieved with the use of computed tomography (CT) guidance. The rapid on‑site evaluation (ROSE) method allows for quick assessment of the features, cytomorphological traits, and appropriateness of the obtained tissue samples, and might further accelerate the diagnostic workup.

Aim: We aimed to investigate the diagnostic value of CT‑guided aspiration biopsy combined with ROSE for assessment of pulmonary lesions.

Materials and methods: A PubMed and Embase search was undertaken until October 2023 to find studies on lung lesion diagnosis utilizing CT‑guided needle biopsy and ROSE. The main method for assessing bias and relevance was the updated Quality Assessment of Diagnostic Accuracy Research 2 tool. The threshold effect and subgroup analysis were used to determine the source or heterogeneity. Sensitivity, specificity, diagnostic odds ratio (DOR), area under the summary receiver operating characteristics curve (SROC AUC), and the Q‑index were calculated. The Deek funnel plot was used to evaluate publication bias.

Results: A total of 6 studies (n = 951) with mild heterogeneity were included in this meta‑analysis, yielding a pooled sensitivity, specificity, and DOR of 0.94 (95% CI, 0.91-0.96), 0.95 (95% CI, 0.9-0.98), and 159.05 (95% CI, 69.59-363.49), respectively. The SROC AUC, calculated using a random‑effects model, was 0.98. Subgroup analysis showed that study design (prospective vs retrospective) had an impact on sensitivity. Further analysis of 3 studies that established control groups showed that the ROSE group had by 12% (95% CI, 0.08-0.16; I² = 0) higher sampling adequacy and diagnostic accuracy than the non‑ROSE group, while there was no significant difference in the rate of complications.

Conclusions: For assessment of pulmonary lesions, CT‑guided puncture biopsy combined with ROSE has high sensitivity, specificity, and diagnostic accuracy, and is a practical operational method that merits wide clinical application.