Original Title: Uso combinado de la tomografía computarizada de haz cónico y otras técnicas de navegación para el diagnóstico de nódulos pulmonares

Authors' objectives: To evaluate the effectiveness and safety of the use of CBCT, alone or in combination with other techniques, in assisting bronchoscopy for obtaining lung nodule biopsies.

Authors' results and conclusions: Results A systematic review, two primary studies and a economic study have been included, out of a total of 1688 references. The evidence identified is limited due to problems of bias in the systematic review, the small number of patients in the primary studies and the heterogeneity caused by the use of different technologies in combination with the index test (CBCT). In the included meta-analysis, the diagnostic yield results of the five primary studies that used CBCT as the only guiding technique in bronchoscopy were synthesized with a result of 78.2 %. The results of the 10 primary studies employing CBCT with other techniques (electromagnetic assisted bronchoscopy, robot assisted bronchoscopy or virtual navigation bronchoscopy) resulted in a cumulative diagnostic yield of 77.4 %. There was no statistically significant difference between the subgroups that included CBCT and those that did not (p = 0.091). In one included study a total of 49 patients were randomised, 25 in the CBCT group and 24 in the fluoroscopy-guided group. The diagnostic yield was 80 % in the former and 42 % in the latter. Another study included 47 patients in the CBCT plus fluoroscopy group, a group in which a diagnostic yield of 61.7 % was determined and included 40 patients in the electro-magnetic navigation group, obtaining a diagnostic yield of 50 % in this group. In the interventions that used CBCT, alone or in combination with other techniques, any type of adverse event occurred in 4 % of patients, compared to 6.3 % in electromagnetic navigation subgroup, 5.7 % in robotic bronchoscopy and 4.7 % in virtual navigation bronchoscopy. Pneumothorax occurred in 1.8 % of interventions with CBCT, 3.4 % with electromagnetic navigation, 1.3 % with virtual bronchoscopy navigation and 2.7 % with robotic assisted bronchoscopy. Conclusions With limited evidence due to the small number of patients and variability in the technologies used alongside the index test (CBCT) and as comparators, diagnosis of pulmonary nodules from CBCT-guided bronchoscopy may offer similar efficacy in terms of diagnostic yield to other guided bronchoscopy techniques. In terms of safety, the ionising radiation to which the patient is subjected is increased, but the risk of pneumothorax, bleeding and adverse events is equivalent to that of other imaging modalities and/or bronchoscopy navigation assistance. Larger prospective studies are needed to compare with transthoracic tests, both in determining efficacy and to establish the extent to which the risk of pneumothorax and other complications from using a less invasive test than transthoracic needles is reduced.

Authors' methods: Systematic review of the literature including health technology assessment reports, systematic reviews, primary studies and economic studies. The following reference databases were consulted up to July 2024 (with free and controlled language): Medline, Embase, Cochrane Library, Web of Science (WOS), INAHTA, RedETS, Trip Pro Medical Database, and the clinical trial registries ClinicalTrails.gov, ICTRP Search Portal y CENTRAL. También se exploraron las webs de las agencias de evaluación de tecnologías CADTH, NICE, AHRQ, HIQA y ECRI. The selection of studies and analysis of their quality were performed by two independent investigators. Synthesis of the results was carried out qualitatively. The quality of the studies was assessed using the AMSTAR-2 tool for systematic reviews and QUADAS 2 for diagnostic test studies.

Project Status: Completed

URL for project: https://www.aetsa.org/publicacion/uso-combinado-de-la-tomografia-computarizada-de-haz-conico-y-otras-tecnicas-de-navegacion-para-el-diagnostico-de-nodulos-pulmonares/

Year Published: 2025

URL for published report: https://www.aetsa.org/download/publicaciones/69_2024_AETSA_TC-Cone-Beam_web.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

DOI: 10.52766/RJSM4328

Organisation Name: Andalusian Health Technology Assessment Area

Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309

Contact Name: aetsa.csalud@juntadeandalucia.es

Contact Email: aetsa.csalud@juntadeandalucia.es

Copyright: <p>Andalusian Agency for Health Technology Assessment (AETSA)</p>