Thoracic ultrasound-guided real-time pleural biopsy in the diagnosis of pleural diseases: a systematic review and meta-analysis

Real-time thoracic ultrasound-guided pleural biopsy (TUSPB) is an important diagnostic method for pleural diseases. Traditional two-dimensional thoracic ultrasound, as well as newly developed contrast-enhanced ultrasound (CEUS) and ultrasound elastography (UE), are all used as guidance tools for pleural biopsies. Herein, we aimed to determine the diagnostic yield of real-time TUSPB for pleural diseases to better inform the decision-making process. A literature search of the MEDLINE/PubMed, Embase, and Cochrane Library databases was performed up to June 2023. A binary random-effects model was applied to determine the pooled diagnostic yield. Fifteen studies comprising 1553 patients with pleural diseases were included and analyzed. The overall diagnostic yield of TUSPB for pleural diseases was 85.58% (95% confidence interval [CI]: 81.57–89.58%). The sensitivity was 77.56% for pleural malignancy and 80.13% for tuberculous pleurisy. The sub-analysis result revealed that CEUS-guided pleural biopsy provided a pooled diagnostic yield of 98.24%, which was higher than that of conventional TUSPB (78.97%; p < 0.01). The overall proportion of adverse events for TUSPB was 6.68% (95% CI: 5.31–8.04%). Conventional TUSPB has good pooled diagnostic yields and high safety. CEUS and UE are promising guidance tools for pleural biopsy with the potential to increase diagnostic yield.实时胸腔超声引导下胸膜活检（Real-time thoracic ultrasound-guided pleural biopsy, TUSPB）是胸膜疾病的重要诊断手段。传统二维胸腔超声，以及新近研发的对比增强超声（contrast-enhanced ultrasound, CEUS）与超声弹性成像（ultrasound elastography, UE），均可用作胸膜活检的引导工具。本研究旨在明确实时TUSPB对胸膜疾病的诊断效能，以更好地指导临床决策。我们检索了截至2023年6月的MEDLINE/PubMed、Embase及Cochrane Library数据库，采用二分类随机效应模型计算合并诊断效能。最终纳入并分析了15项研究，共涉及1553例胸膜疾病患者。实时TUSPB针对胸膜疾病的总体诊断效能为85.58%（95%置信区间[CI]：81.57–89.58%）；其中针对胸膜恶性肿瘤的敏感性为77.56%，针对结核性胸膜炎的敏感性为80.13%。亚组分析结果显示，对比增强超声引导下胸膜活检的合并诊断效能达98.24%，高于常规TUSPB的78.97%（p < 0.01）。实时TUSPB的总体不良事件发生率为6.68%（95%CI：5.31–8.04%）。常规TUSPB具备良好的合并诊断效能与较高安全性，对比增强超声与超声弹性成像均为颇具前景的胸膜活检引导工具，有望提升诊断效能。