title: A Systematic Review and Meta-Analysis of C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Nodules.
abstract: BACKGROUND
  A systematic review and meta-analysis of all available publications was performed to evaluate the diagnostic accuracy of percutaneous transthoracic needle biopsy (PTNB) using a C-Arm Cone-Beam CT (CBCT) system in patients with lung nodules.
  
  
  METHODS
  Thedatabases of PUBMED, OVID, EBSCO, EMBASE, and China National Knowledge Infrastructure (CNKI) were systematically searched for relevant original articles on the diagnostic accuracy of CBCT-guided PTNB for the diagnosis of nodules in the lungs. Diagnostic indices including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and diagnostic score (DS) were calculated. Moreover,summary receiver operating characteristic curves (SROC) were constructed with Stata (version 13.0), Rev Man (version 5.3), and Meta-disc (version 1.4) software. Other clinical indices such as incidence of complications were also recorded.
  
  
  RESULTS
  Eight studies met the inclusion and exclusion criteria for the meta-analysis. The pooled sensitivity, specificity, PLR, NLR, DOR, DS, and SROC with 95% confidence intervals were 0.96 (0.93-0.98), 1.00 (0.91-1.00), 711.15 (9.48-53325.89), 0.04 (0.02-0.07), 16585.29 (284.88-9.7e+05), 9.72 (5.65-13.78), and 0.99 (0.97-0.99), respectively. The incidence of pneumothorax and hemorrhage was 10-29.27% and 1.22-47.25%, respectively.
  
  
  CONCLUSIONS
  CBCT-guided PTNB has an acceptable rate of complications and is associated with a reasonable radiation exposure. Moreover, it is a highly accurate and safe technique for the diagnosis of lung nodules and can be recommended to be used in routine clinical practice.
authors.affiliation: Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China.
authors.forename: Gao-Wu
authors.initials: GW
authors.lastname: Yan
authors.affiliation: Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China.
authors.forename: Anup
authors.initials: A
authors.lastname: Bhetuwal
authors.affiliation: Department of Radiology, The First People's Hospital of Suining City, Suining, Sichuan, P.R. China.
authors.forename: Gao-Wen
authors.initials: GW
authors.lastname: Yan
authors.affiliation: Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China.
authors.forename: Qin-Quan
authors.initials: QQ
authors.lastname: Sun
authors.affiliation: Department of Radiology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, P.R. China.
authors.forename: Xiang-Ke
authors.initials: XK
authors.lastname: Niu
authors.affiliation: Department of Cardio-Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Gastrointestinal of Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China.
authors.forename: Li-Fa
authors.initials: LF
authors.lastname: Li
authors.affiliation: School of Basic Medical Sciences, North Sichuan Medical College, Nanchong, Sichuan, P.R. China.
authors.forename: Bin-Zhong
authors.initials: BZ
authors.lastname: Li
authors.affiliation: Department of Radiology, Suining Central Hospital, Suining, Sichuan, P.R. China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zeng
authors.affiliation: Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China.
authors.forename: Bing
authors.initials: B
authors.lastname: Li
authors.affiliation: Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China.
authors.forename: Xiao-Xue
authors.initials: XX
authors.lastname: Xu
authors.affiliation: Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China.
authors.forename: Han-Feng
authors.initials: HF
authors.lastname: Yang
authors.affiliation: Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Du
keywords: Biopsy; Cone-Beam Computed Tomography; Lung; Review