Comparison between closed pleural biopsy and medical thoracoscopy for the diagnosis of undiagnosed exudative pleural effusions: a systematic review and meta-analysis

Yuqing Wei; Kaikai Shen; Tangfeng Lv; Hongbing Liu; Zimu Wang; Juan Wu; He Zhang; Sara Colella; Fu-Zong Wu; Michael T Milano; Ping Zhan; Yong Song; Zhiwei Lu; written

doi:10.21037/tlcr.2020.03.28

Comparison between closed pleural biopsy and medical thoracoscopy for the diagnosis of undiagnosed exudative pleural effusions: a systematic review and meta-analysis

Transl Lung Cancer Res. 2020 Jun;9(3):446-458. doi: 10.21037/tlcr.2020.03.28.

Authors

Yuqing Wei^{1

2}, Kaikai Shen³, Tangfeng Lv², Hongbing Liu², Zimu Wang², Juan Wu⁴, He Zhang¹, Sara Colella⁵, Fu-Zong Wu^{6

7}, Michael T Milano⁸, Ping Zhan², Yong Song², Zhiwei Lu¹; written

Affiliations

¹ Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu 241000, China.
² Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China.
³ Department of Critical Care Medicine, Yijishan Hospital of Wannan Medical College, Wuhu 241000, China.
⁴ Department of Pathology and Pathophysiology, Wannan Medical College, Wuhu 241002, China.
⁵ "UOC Pneumologia," "C. e G. Mazzini" Hospital, Ascoli Piceno, Italy.
⁶ Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung.
⁷ Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang Ming University, Taipei.
⁸ Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.

Abstract

Background: Exudative pleural effusion (EPE) is a common diagnostic challenge. The utility of medical thoracoscopy (MT) and closed pleural biopsy (CPB) to aid in the diagnosis of EPE has been reported in many published studies. Herein, we perform a systematic review and meta-analysis to compare the diagnostic yield and safety of CPB and MT in EPE.

Methods: Four databases were searched for studies reporting the diagnostic yield of CPB and MT for EPE. The quality of the included studies was evaluated according to the quality assessment of diagnostic accuracy studies (QUADAS) tool. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and complication risks were compared between the two groups.

Results: Ten studies dealing with CPB and twenty-three studies dealing with MT for the diagnosis of EPE were included in this meta-analysis. Pooled sensitivity, specificity, PLR, NLR and DOR of CPB group was 77%, 99%, 32.55, 0.22, 165.71, respectively, while pooled sensitivity, specificity, PLR, NLR and DOR of MT group was 93%, 100%, 10.82, 0.08, 162.81, respectively. The area under the summary receiver operating characteristic (SROC) curve of CPB and MT were both 0.97. The ability of CPB to diagnose non-malignant diseases was like MT (69% vs. 68%), while the ability was lower than that of MT to diagnose malignant diseases (72% vs. 92%). The pooled diagnostic accuracy of CPB and MT for mesothelioma was 26% (95% CI, 14-38%) and 42% (95% CI, 22-62%) (P<0.001), respectively. The rate of complications with CBP was lower than that reported for MT.

Conclusions: CBP is a relatively accurate tool with a lower complication rate compared to MT in the diagnosis of EPE, especially in diagnosing non-malignant diseases. We confirm the utility of MT in the diagnostic workup of malignancy (especially mesothelioma); however, in selected cases, CPB could be used as the first diagnostic approach with a favorable safety profile.

Keywords: Closed pleural biopsy (CPB); diagnosis; exudative pleural effusion (EPE); medical thoracoscopy (MT); meta-analysis.