Supplementary Material for: Meta-Analysis on Utility of Bronchoscopy in Addition to Computed Tomography Thorax in the Investigation of Lung Cancer in Patients with Haemoptysis

Background: In patients with haemoptysis, many healthcare systems support bronchoscopy regardless of computed tomography (CT) findings. Objective: This meta-analysis aimed to address whether a normal CT alone is sufficient to out-rule lung cancer in patients with haemoptysis. Methods: A search was performed of the following databases: EBSCO (Medline), PubMed, Academic Search Complete, CINAHL, Cochrane Library, and Embase. Meta-Disc 1.4 and RevMan software were used to test for heterogeneity, risk of bias, and to summarize the test performance characteristics using forest plots and summary receiver operating characteristic (SROC) curves. SPSS was used to compare the diagnostic accuracy of CT and bronchoscopy. Results: A total of 14 studies (2,960 patients) were included. The pooled sensitivities for detection of lung cancer using CT scan and bronchoscopy were 0.99 (95% CI: 0.97–1.00) and 0.84 (95% CI: 0.78–0.88), respectively. The sensitivity of CT was higher than that of bronchoscopy (p < 0.001). The pooled specificities for CT scan and bronchoscopy were 0.99 (95% CI: 0.99–1.00) and 1.00 (95% CI: 0.99–1.00), respectively. Of 2,960 patients, 257 had lung cancer (8.7%) at initial investigation. 254 of these had a CT thorax, and the CT scan was false negative in 4/255 (1.6%), with bronchoscopy only identifying one cancer with a normal CT (0.4%). Conclusion: CT scan showed a higher diagnostic accuracy than bronchoscopy. This study indicated that bronchoscopy offers an insignificant additional value in the investigation of lung cancer in patients with haemoptysis and a negative CT scan.

背景：对于咯血患者，诸多医疗体系均支持开展支气管镜检查，无需考虑计算机断层扫描（CT）的检查结果。
目的：本荟萃分析旨在明确，仅凭借正常CT结果是否足以排除咯血患者罹患肺癌的可能性。
方法：检索了以下数据库：EBSCO（Medline）、PubMed、Academic Search Complete、护理及相关健康文献累积索引（CINAHL）、考克兰图书馆（Cochrane Library）以及Embase。采用Meta-Disc 1.4与RevMan软件开展异质性检验、偏倚风险评估，并通过森林图及汇总受试者工作特征（SROC）曲线总结试验的性能特征。使用SPSS软件比较CT与支气管镜检查的诊断准确度。
结果：共计纳入14项研究，涉及2960例患者。CT扫描与支气管镜检查检出肺癌的合并灵敏度分别为0.99（95%置信区间：0.97–1.00）与0.84（95%置信区间：0.78–0.88），CT的灵敏度高于支气管镜检查（p < 0.001）。CT扫描与支气管镜检查的合并特异度分别为0.99（95%置信区间：0.99–1.00）与1.00（95%置信区间：0.99–1.00）。在2960例患者中，初查确诊肺癌者共257例，占比8.7%。其中254例接受了胸部CT检查，CT假阴性结果共4/255（1.6%）；支气管镜仅检出1例CT结果正常的肺癌患者（0.4%）。
结论：CT扫描的诊断准确度高于支气管镜检查。本研究表明，对于咯血且CT结果为阴性的患者，支气管镜检查在肺癌排查中仅能提供可忽略不计的额外诊断价值。