Computed tomography-guided biopsy for sub-centimetre pulmonary nodules: a meta-analysis

Introduction
Pulmonary nodules (PNs) with a diameter from 5 to 10 mm exhibit malignancy rates anywhere from 47.5 to 61.5%. Despite the potential danger posed by these lesions, their small size makes the biopsy of these sub-centimetre (≤ 10 mm) PNs under computed tomography (CT) guidance very difficult.

Aim
A meta-analysis was performed with the goal of evaluating the safety and diagnostic utility of CT-guided biopsy procedures for sub-centimetre PNs.

Material and methods
Relevant studies published through April 2023 were identified in the PubMed, Web of Science, and Wanfang databases and used to conduct pooled analyses of selected endpoints, including technical success, diagnostic yield, diagnostic accuracy, pulmonary haemorrhage, and pneumothorax rates.

Results
In total, this meta-analysis incorporated 10 studies in which 1482 patients with sub-centimetre PNs underwent CT-guided biopsy procedures. Among these patients, the respective pooled rates of technical success, diagnostic yield, diagnostic accuracy, pulmonary haemorrhage, and pneumothorax were 90%, 60%, 91%, 11%, and 24%, and significant heterogeneity was detected for all of these endpoints (I2 = 93.6%, 96%, 76.9%, 80.8%, and 93.6%). A substantial difference in diagnostic accuracy was observed when comparing biopsy procedures performed using fine- and core-needle biopsy approaches (85% vs. 95%), whereas the use of the co-axial method or the selected guidance approach (conventional vs. cone-beam CT) had no impact on diagnostic accuracy. Needle type, guidance method, and co-axial method use had no impact on the rates of pulmonary haemorrhage or pneumothorax.

Conclusions
CT-guided biopsy represents a safe and effective means of accurately diagnosing sub-centimetre PNs.