Thoracic ultrasound-guided real-time pleural biopsy in the diagnosis of pleural diseases: a systematic review and meta-analysis

ABSTRACTBackground Real-time thoracic ultrasound-guided pleural biopsy (TUSPB) is an important diagnostic method for pleural diseases. Traditional two-dimensional thoracic ultrasound, as well as newly developed contrast-enhanced ultrasound (CEUS) and ultrasound elastography (UE), are all used as guidance tools for pleural biopsies. Herein, we aimed to determine the diagnostic yield of real-time TUSPB for pleural diseases to better inform the decision-making process.Methods A literature search of the MEDLINE/PubMed, Embase, and Cochrane Library databases was performed up to June 2023. A binary random-effects model was applied to determine the pooled diagnostic yield.Results Fifteen studies comprising 1553 patients with pleural diseases were included and analyzed. The overall diagnostic yield of TUSPB for pleural diseases was 85.58% (95% confidence interval [CI]: 81.57–89.58%). The sensitivity was 77.56% for pleural malignancy and 80.13% for tuberculous pleurisy. The sub-analysis result revealed that CEUS-guided pleural biopsy provided a pooled diagnostic yield of 98.24%, which was higher than that of conventional TUSPB (78.97%; p < 0.01). The overall proportion of adverse events for TUSPB was 6.68% (95% CI: 5.31–8.04%).Conclusion Conventional TUSPB has good pooled diagnostic yields and high safety. CEUS and UE are promising guidance tools for pleural biopsy with the potential to increase diagnostic yield.KEYWORDS: Thoracic ultrasound-guided pleural biopsypleural diseasecontrast-enhanced ultrasoundultrasound elastographypleural biopsyDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Author contributionsG Hou contributed to conception and design of the study. Q Zhang, M Deng and Y Lu screened the articles. Q Zhang and M Deng extracted the data. Q Z and X Li performed the statistical analysis and interpretation. Q Zhang wrote the first draft of the manuscript. G Hou, Q Zhang, M Deng, Y Lu, and X Li revised it critically for intellectual content. All authors approve the version to be published and agree to be accountable for all aspects of the work.AbbreviationsTUSPB, thoracic ultrasound-guided pleural biopsy; CEUS, contrast-enhanced ultrasound; CI, confidence interval; CT, computed tomography; UE, ultrasound elastography; UEPB, UE-guided pleural biopsy; CRS, composite reference standard; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; QUADAS-2, Quality Assessment of Diagnostic Accuracy Studies.Declaration of interestThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresA reviewer on this manuscript has disclosed that they were the first author on one of the studies this SR/Meta-analysis has included in this review. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.Figure 1. Flow diagram of the systematic review process.Display full sizeFigure 2. Diagnostic yield of real-time thoracic ultrasound-guided pleural biopsy for pleural lesions.Abbreviations: TUSPB, thoracic ultrasound-guided pleural biopsy; CEUS, contrast-enhanced ultrasound; UEPB, ultrasound elastography guided pleural biopsy.Display full sizeFigure 3. Funnel plot for included publications.Display full sizeFigure 4. Sensitivity of real-time thoracic ultrasound-guided pleural biopsy in patients with pleural malignancy.Abbreviation: TUSPB, thoracic ultrasound-guided pleural biopsy; CEUS, contrast-enhanced ultrasound; UEPB, ultrasound elastography guided pleural biopsy.Display full sizeFigure 5. Incidence of real-time thoracic ultrasound-guided pleural biopsy related adverse eventsDisplay full sizeAdditional informationFundingThis work was supported by the China-Japan Friend-ship Hospital under Grant 2022-NHLHCRF-LX-01 and ZRJY2021-BJ08; Chinese Academy of Medical Sciences under Grant 2020-PT320-001.