Supplementary Material for: Diagnostic Yield and Safety of Electromagnetic Navigation Bronchoscopy for Lung Nodules: A Systematic Review and Meta-Analysis

<b><i>Background:</i></b> Electromagnetic navigation bronchoscopy (ENB) is an emerging endoscopic technique for the diagnosis of peripheral lung lesions. A thorough analysis of ENB's yield and safety is required for comparison to other sampling modalities. <b><i>Objectives:</i></b> To describe ENB's yield and safety profile. <b><i>Methods:</i></b> The MEDLINE and EMBASE databases were systematically searched for studies reporting ENB's yield for peripheral lung lesions. Two independent investigators extracted data and rated each study on a scale of methodological quality. Clearly defined performance outcomes were reconstructed and meta-analyzed. Subgroup analysis and meta-regression were used to identify possible sources of study heterogeneity. <b><i>Results:</i></b> A total of 15 trials were included (1,033 lung nodules). A positive and definitive diagnosis was obtained after 64.9% of all ENB procedures (95% CI 59.2-70.3). Overall diagnostic accuracy was 73.9% (95% CI 68.0-79.2). Sensitivity to detect cancer was 71.1% (95% CI 64.6-76.8), with a negative predictive value of 52.1% (95% CI 43.5-60.6). Pneumothorax occurred in 3.1% of patients, requiring chest tube drainage in 1.6% of these cases. Original trials identified 6 variables associated with higher ENB yields: nodule location in the upper or middle lobes, nodule size, lower registration error, presence of a bronchus sign on CT imaging, combined use of an ultrasonic radial probe, and catheter suctioning as a sampling technique. Heterogeneity exploration revealed that studies using general anesthesia or rapid on-site cytological evaluation reported better yields. <b><i>Conclusions:</i></b> ENB is effective and particularly safe. Prospective studies are needed to clarify the role of several variables conditioning the yield of this technique.

<b><i>背景：</i></b> 电磁导航支气管镜（Electromagnetic navigation bronchoscopy, ENB）是一种新兴的内镜技术，用于周围性肺部病变的诊断。为与其他采样方式进行对比，需对ENB的诊断效能与安全性开展全面分析。<b><i>研究目的：</i></b> 阐明ENB的诊断效能及安全性特征。<b><i>研究方法：</i></b> 系统检索MEDLINE与EMBASE数据库，筛选报道ENB用于周围性肺部病变诊断效能的相关研究。由两名独立研究者提取数据，并按照方法学质量评分标准对每项研究进行评级。对明确界定的性能指标进行重构并开展荟萃分析。采用亚组分析与荟萃回归识别研究异质性的潜在来源。<b><i>研究结果：</i></b> 最终纳入15项临床试验，共涉及1033个肺结节。所有ENB操作后确诊率为64.9%（95%置信区间：59.2~70.3）。整体诊断准确率为73.9%（95%置信区间：68.0~79.2）。检测恶性肿瘤的敏感性为71.1%（95%置信区间：64.6~76.8），阴性预测值为52.1%（95%置信区间：43.5~60.6）。气胸发生率为3.1%，其中1.6%的患者需接受胸腔闭式引流。初始研究共识别出6项与ENB更高诊断效能相关的变量：结节位于上叶或中叶、结节大小、配准误差更低、CT影像可见支气管征、联合使用径向超声探针、采用导管抽吸作为采样技术。异质性分析显示，采用全身麻醉或术中快速细胞学评估的研究报告了更高的诊断效能。<b><i>研究结论：</i></b> ENB具有良好的诊断效能与安全性。仍需开展前瞻性研究以明确若干影响该技术诊断效能的变量的具体作用。