Preoperative localization for lung nodules: a meta-analysis of bronchoscopic versus computed tomography guidance

Introduction
Both computed tomography (CT)-guided and bronchoscopic localization strategies have been utilized prior to video-assisted thoracic surgery (VATS) as a means of achieving high lung nodule (LN) wedge resection success rates. Aim: The present meta-analysis was thus developed for the assessment of the efficacy and safety of preoperative CT-guided and bronchoscopic LN localization approaches.

Material and methods
The PubMed, Cochrane Library, Embase, and Wanfang databases were searched for all relevant studies published through May 2022, with RevMan v5.3 being used to conduct pooled analyses of data pertaining to all endpoints of interest.

Results
In total, this meta-analysis incorporated data from 7 retrospective studies including 321 patients bearing 353 LNs that underwent CT-guided localization and 220 patients bearing 244 LNs that underwent bronchoscopic localization. When comparing the CT and bronchoscopic localization approaches, pooled rates of technical success (p = 0.20) and duration of localization (p = 0.20) were comparable. However, bronchoscopic localization was associated with significantly lower pooled rates of pneumothorax (p < 0.001) and pulmonary hemorrhage (p = 0.005) relative to CT-guided localization. In the CT group, the pooled VATS duration was significantly shorter compared with the bronchoscopic group (p = 0.04), although the pooled duration of postoperative hospitalization was comparable in both groups (p = 0.69). The heterogeneity was significant with respect to both the duration of localization (I2 = 97%) and the duration of postoperative hospitalization (I2 = 74%).

Conclusions
Relative to a CT-guided localization approach, the bronchoscopic localization of LNs can achieve similar clinical efficacy and superior safety.