Diagnostic approaches to solitary pulmonary nodule (SPN)

Syful Azlie MF, Erni ZR
Record ID 32018001253
Authors' objectives: To assess the overall diagnostic performance of guided bronchoscopy techniques for tissue biopsy of SPN in the management of lung cancer in Malaysia.
Authors' results and conclusions: Diagnostic accuracy: The combined use of navigation bronchoscopy (virtual or electromagnetic) with radial probe or radial endobronchial ultrasound (r-EBUS) improves overall test performance characteristics beyond either technique alone but lower than percutaneous CT-guided biopsy or computerized-assisted transthoracic needle aspiration (TTNA); typically varying with lesion size, location, and equipment used as well as other factors including the presence of a bronchus sign, biopsy technique, and institution expertise or learning curve of the operator. Safety: The major strength of guided bronchoscopic biopsy techniques is clearly its safety profile, especially regarding the risk of procedure-related pneumothorax and haemorrhage, which is about 10 times lower than conventional bronchoscopy or CT-guided biopsy. Economic implication: Guided bronchoscopy biopsy techniques was found to be cost-effective when a sequential diagnostic strategy that combines CT-guided biopsy and ENB were applied, whereas r-EBUS and CT-PNB differ in cost by negligible amounts. When cancer prevalence was high, tissue acquisition of NB and CT-FNA was the most cost-effective strategies.
Authors' recomendations: Guided bronchoscopy techniques mainly using a combination of virtual bronchoscopy navigation (VBN) or electromagnetic navigation bronchoscopy (ENB) with r-EBUS are an appropriate biopsy approaches to SPN and may be used for management of patients with lung cancer in selected centres in MOH hospitals, provided local expertise is available.
Authors' methods: Literature search was conducted by an Information Specialist who searched for published articles pertaining to guided bronchoscopy techniques for tissue biopsy of SPN in the management of lung cancer. The following electronic databases were searched through the Ovid interface: Ovid MEDLINE® and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions® 1946 to January 2020, EBM Reviews - Health Technology Assessment (4th Quarter 2016), EBM Reviews - Cochrane Database of Systematic Review (2005 to January 2020), EBM Reviews - Cochrane Central Register of Controlled Trials (December 2019), and EBM Reviews - NHS Economic Evaluation Database (1st Quarter 2016). Parallel searches were run in PubMed, US FDA and INAHTA database. No limits were applied to the search. The last search was performed on 2nd March 2020. Additional articles were identified from reviewing the references of retrieved articles.
Project Status: Completed
Year Published: 2020
Requestor: Ministry of Health
English language abstract: An English language summary is available
Publication Type: Full HTA
Country: Malaysia
MeSH Terms
  • Diagnostic Techniques, Respiratory System
  • Pulmonary Valve
  • Solitary Pulmonary Nodule
  • Lung Neoplasms
  • Bronchoscopy
Organisation Name: Malaysian Health Technology Assessment
Contact Address: Malaysian Health Technology Assessment Section, Ministry of Health Malaysia, Federal Government Administrative Centre, Level 4, Block E1, Parcel E, 62590 Putrajaya Malaysia Tel: +603 8883 1229
Contact Name: htamalaysia@moh.gov.my
Contact Email: htamalaysia@moh.gov.my
Copyright: Malaysian Health Technology Assessment Section (MaHTAS)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.