Systematic review and meta-analysis of low-dose CT-driven biopsy for pulmonary nodules

Introduction
The diagnosis of pulmonary nodules (PNs) has traditionally relied on computed tomography (CT)-guided biopsy. To reduce radiation exposure, low-dose CT-guided PN biopsy has been employed.

Aim
This meta-analysis aimed at evaluating the efficacy and safety of low-dose CT-guided biopsy in the diagnosis of PNs.

Material and methods
PubMed, Web of Science, and Wanfang were searched for relevant articles until June 2023. Comparing low-dose CT to normal-dose CT, we considered factors such as diagnostic yield, diagnostic accuracy, biopsy process time, dose-length product (DLP) value, the frequency of pneumothorax and pulmonary bleeding, and the frequency with which complications necessitated the placement of a chest tube.

Results
This meta-analysis included data from a total of 6 investigations. There was a total of 459 patients who had a CT-guided PN biopsy performed at a low dosage, and 384 patients who had a normal-dose CT-guided PN biopsy. There were no statistically significant differences between the low-dose CT and normal-dose CT groups in terms of diagnostic accuracy (p = 0.08), diagnostic yield (p = 0.55), biopsy procedure duration (p = 0.30), pneumothorax (p = 0.61), pulmonary hemorrhage (p = 0.29), or complications requiring a chest tube (p = 0.48). Low-dose CT patients obtained a DLP that was 91% lower than those in the standard-dose CT group (p = 0.01). According to Egger’s test, there is a significant possibility of publication bias in DLP (p = 0.034).

Conclusions
The diagnostic and safety results of low-dose CT-driven PN biopsy are equivalent to those of the standard one, although patients are much less exposed to radiation.