Systematic Review and Meta-Analysis of Lung Cancer Diagnostic Methods by the Brazilian Thoracic Oncology Group (GBOT)

Although various techniques are available for diagnosing lung cancer (LC), comprehensive literature synthesis for selecting the most appropriate diagnostic method remains lacking. This study aims to synthesize and meta-analyze the diagnostic accuracy of bronchoscopy and transthoracic needle biopsy (TTNB) in LC diagnosis.

A systematic review was conducted to evaluate the diagnostic accuracy of bronchoscopy and TTNB for LC diagnosis. MEDLINE/PubMed, EMBASE, Web of Science, Cochrane Library, and LILACS were systematically searched to identify relevant studies. We included original diagnostic accuracy studies with over 50 participants comparing bronchoscopy or TTNB to surgical biopsy or clinical follow-up. Data were synthesized using a bivariate diagnostic accuracy random-effects model, and the quality of evidence was assessed using QUADAS-2.

The search identified 3,707 bronchoscopy studies, of which two met inclusion criteria, precluding meta-analysis because of high heterogeneity. For TTNB, 1,136 studies were screened, with 20 included. Meta-analysis of TTNB studies revealed pooled sensitivity and specificity of 0.91 (95% CI, 0.90 to 0.93) and 0.99 (95% CI, 0.98 to 1.00), respectively. Likelihood ratios indicated high post-test probability of accurate diagnosis across clinical scenarios.

TTNB demonstrates good diagnostic accuracy for peripheral lung lesions, but carries notable complication risks. Bronchoscopy, while less sensitive, remains valuable for central lesions and mediastinal evaluation. These findings underscore the need for a tailored diagnostic approach on the basis of lesion characteristics and patient profiles, complemented by multidisciplinary expertise.