title: Transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis.
abstract: Fluoroscopy-guided transbronchial needle aspiration (TBNA) has long been used in the diagnosis of peripheral pulmonary lesions (PPLs), although its diagnostic performance varies considerably.We conducted a systematic review and meta-analysis evaluating the accuracy of TBNA in the diagnosis of PPLs, comparing its diagnostic yield with transbronchial biopsy (TBB) and assessing the main predictors of a successful aspirate.In 18 studies, the overall TBNA yield was 0.53 (95% CI 0.44-0.61). TBNA showed a higher accuracy when directly compared to TBB (0.60 (95% CI 0.49-0.71) versus 0.45 (95% CI 0.37-0.54)). The subgroup analyses documented a higher TBNA yield when the computed tomography (CT) bronchus sign was present (0.70 (95% CI 0.63-0.77) versus 0.51 (95% CI 0.38-0.64)), when rapid on-site evaluation (ROSE) was performed (0.62 (95% CI 0.43-0.79) versus 0.51 (95% CI 0.42-0.60)), in the case of malignant lesions (0.55 (95% CI 0.44-0.66) versus 0.17 (95% CI 0.11-0.24)) and for lesions >3 cm (0.81 (95% CI 0.73-0.87) versus 0.55 (95% CI 0.47-0.63)).Conventional TBNA is a useful sampling technique for the diagnosis of PPL, with a higher diagnostic yield than TBB. The presence of CT bronchus sign, an underlying malignant process, lesion size >3 cm and ROSE employment are predictors of a higher yield.
authors.affiliation: Respiratory Unit, San Paolo Hospital, Dept of Scienze della Salute, Università degli Studi di Milano, Milan, Italy michele.mondoni@ao-sanpaolo.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Mondoni
authors.affiliation: Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari-Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sotgiu
authors.affiliation: Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy Pulmonology Unit, AOU "Ospedali Riuniti", Ancona, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Bonifazi
authors.affiliation: Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari-Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Dore
authors.affiliation: Respiratory Unit, San Paolo Hospital, Dept of Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
authors.forename: Elena Maria
authors.initials: EM
authors.lastname: Parazzini
authors.affiliation: Respiratory Unit, San Paolo Hospital, Dept of Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Carlucci
authors.affiliation: Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy Pulmonology Unit, AOU "Ospedali Riuniti", Ancona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Gasparini
authors.affiliation: Respiratory Unit, San Paolo Hospital, Dept of Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Centanni
mesh_terms: D001707:Biopsy, Needle / Q000379:methods*; D001999:Bronchoscopy; D005471:Fluoroscopy; D006801:Humans; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D012449:Safety; D014057:Tomography, X-Ray Computed