Home > DARE Reviews > Radial probe endobronchial ultrasound...

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis

DP Steinfort, YH Khor, RL Manser, and LB Irving.

Review published: 2011.

Link to full article: [Journal publisher]

CRD summary

Radial probe endobronchial ultrasound was a safe and relatively accurate tool in the investigation of peripheral pulmonary lesions. The possibility of missing studies, limitations in the models used to pool data and the poor quality of the included studies mean that the authors' conclusions should be interpreted with some caution.

Authors' objectives

To evaluate the accuracy of radial probe endobronchial ultrasound for diagnosis of peripheral lung cancer.

Searching

PubMed were searched to December 2009. The full search strategy was reported. References in relevant primary studies and reviews were screened. The review was restricted to studies published in English.

Study selection

Primary studies that evaluated radial probe endobronchial ultrasound for diagnosis of peripheral pulmonary lesions in at least 30 patients and that confirmed the diagnosis by histology or close clinical follow-up of at least six months were eligible for inclusion.

Most included studies were prospective cohorts; retrospective audits and randomised controlled trials were included. In most studies, patient selection was based on referral for diagnosis of peripheral pulmonary lesions. Studies also included patients based on peripheral pulmonary lesions not visible at routine bronchoscopy, patients with peripheral pulmonary lesions less than 20mm with computed tomography and patients with confirmed lung cancer. Reference standards included histology by alternate means, surgical resection, radiologic surveillance and follow-up. Prevalence of malignancy across studies was 72%. Mean age, where reported, ranged from 46 to 72 years. Some studies used additional guidance devices.

Two reviewers independently assessed studies for inclusion. Disagreements were resolved through consensus.

Assessment of study quality

Two reviewers independently assessed study quality using the 14-item Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria.

Data extraction

Two reviewers independently extracted data to populate 2x2 tables of test performance. These data were used to calculate sensitivity and specificity together with 95% confidence intervals (CIs).

Methods of synthesis

Summary estimates of sensitivity and specificity together with 95% CIs were estimated using simple fixed-effect pooling. A summary receiver operating characteristic (SROC) plot was estimated using the Moses-Littenberg model. Heterogeneity was assessed with Ι². Linear regression was used to analyse the relationship between continuous variables. Subgroup analysis was conducted by pooling sensitivity data separately according to the variables: use of fluoroscopy, use of guided sheet, median size, prevalence of malignancy and reference standard.

Results of the review

Sixteen studies were included in the review (1,420 participants). Study quality was generally poor; studies fulfilled between two and eight QUADAS items. Only one study included a comparison with a traditional biopsy (an appropriate reference standard). In all studies it was unclear whether an appropriate patient spectrum was enrolled. Thirteen studies (1,090 participants) reported sufficient data to construct a 2x2 table and were included in the meta-analysis.

Sensitivity ranged from 49% to 88% with a summary estimate of 73% (95% CI 70% to 76%). There was substantial heterogeneity across studies (Ι²=75%). Summary specificity was 100% (95% CI 99% to 100%). There was no evidence of heterogeneity (Ι²=0%). Linear regression showed a weak positive association between prevalence of malignancy and sensitivity (p=0.0872). Sensitivity was significantly higher for detection of larger lesions (>20mm) (p=0.007). None of the other features investigated showed a significant association with sensitivity.

Complication rates ranged from zero to 7% (14 studies). Pneumothorax ranged from zero to 5% (1% across studies). The pooled data for intercostal catheter drainage of pneumothorax was 0.4%.

Authors' conclusions

Endobronchial ultrasound was a safe and relatively accurate tool in the investigation of peripheral pulmonary lesions. Sensitivity may be influenced by the prevalence of malignancy in the patient cohort and lesion size.

CRD commentary

The review addressed a clear question and inclusion criteria were defined. The literature search was limited to one electronic database and the review was restricted to studies published in English, so it was likely that relevant studies were missed and there was a risk of language and publication bias. Appropriate steps were taken to minimise bias and errors at all stages of the review process. Study quality was assessed using appropriate criteria and the results were summarised and available as a web appendix. Methods used to pool data were based on simple models; the more robust bivariate/hierarchical SROC models were not used.

The authors' conclusions were supported by the data. It would have been helpful to include very high specificity and more heterogeneous and lower sensitivity in the conclusions. Limitations in the review (possibility of missing studies, limitations in the models used to pool data an the poor quality of the included studies) mean that the authors' conclusions should be interpreted with some caution.

Implications of the review for practice and research

Practice: The authors stated that patients with a non-diagnostic (negative) endobronchial ultrasound should be strongly considered for further investigation to exclude the possibility of cancer.

Research: The authors stated that future studies were required to inform the construction of a clinical algorithm combining radiological and clinical data. Future studies need to clearly outline the patient selection process. There was a need for economic analyses.

Funding

Post-graduate research scholarship from the National Health and Medical Research Council of Australia.

Bibliographic details

Steinfort DP, Khor YH, Manser RL, Irving LB. Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. European Respiratory Journal 2011; 37(4): 902-910. [PubMed: 20693253]

Indexing Status

Subject indexing assigned by NLM

MeSH

Adult; Biopsy; Bronchoscopy /methods; Cohort Studies; Humans; Lung /ultrasonography; Lung Neoplasms /diagnosis /ultrasonography; Middle Aged; Prevalence; ROC Curve; Regression Analysis; Reproducibility of Results; Sensitivity and Specificity; Solitary Pulmonary Nodule /diagnosis /ultrasonography; Ultrasonography /methods

AccessionNumber

12011004786

Database entry date

27/03/2012

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 20693253

Download

PubMed Health Blog...

read all...

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...