Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis

<div><p>Background</p><p>Advances in bronchoscopy and CT-guided lung biopsy have improved the evaluation of small pulmonary lesions (PLs), leading to an increase in preoperative histological diagnosis.</p><p>We aimed to evaluate the efficacy and safety of transbronchial lung biopsy using radial endobronchial ultrasound and virtual bronchoscopic navigation (TBLB-rEBUS&VBN) and CT-guided transthoracic needle biopsy (CT-TNB) for tissue diagnosis of small PLs.</p><p>Methods</p><p>A systematic search was performed in five electronic databases, including MEDLINE, EMBASE, Cochrane Library Central Register of Controlled Trials, Web of Science, and Scopus, for relevant studies in May 2016; the selected articles were assessed using meta-analysis. The articles were limited to those published after 2000 that studied small PLs ≤ 3 cm in diameter.</p><p>Results</p><p>From 7345 records, 9 articles on the bronchoscopic (BR) approach and 15 articles on the percutaneous (PC) approach were selected. The pooled diagnostic yield was 75% (95% confidence interval [CI], 69–80) using the BR approach and 93% (95% CI, 90–96) using the PC approach. For PLs ≤ 2 cm, the PC approach (pooled diagnostic yield: 92%, 95% CI: 88–95) was superior to the BR approach (66%, 95% CI: 55–76). However, for PLs > 2 cm but ≤ 3 cm, the diagnostic yield using the BR approach was improved to 81% (95% CI, 75–85). Complications of pneumothorax and hemorrhage were rare with the BR approach but common with the PC approach.</p><p>Conclusions</p><p>CT-TNB was superior to TBLB-rEBUS&VBN for the evaluation of small PLs. However, for lesions greater than 2 cm, the BR approach may be considered considering its diagnostic yield of over 80% and the low risk of procedure-related complications.</p></div

Complication rates of the included studies in the TBLB-rEBUS&VBN and CT-TNB groups.

<p>Complication rates of the included studies in the TBLB-rEBUS&VBN and CT-TNB groups.</p

Characteristics of the included studies in the TBLB-rEBUS&VBN and CT-TNB groups.

<p>Characteristics of the included studies in the TBLB-rEBUS&VBN and CT-TNB groups.</p

Body Mass Index and Mortality in Korean Intensive Care Units: A Prospective Multicenter Cohort Study

<div><p>Background</p><p>The level of body mass index (BMI) that is associated with the lowest mortality in critically ill patients in Asian populations is uncertain. We aimed to examine the association of BMI with hospital mortality in critically ill patients in Korea.</p><p>Methods</p><p>We conducted a prospective multicenter cohort study of 3,655 critically ill patients in 22 intensive care units (ICUs) in Korea. BMI was categorized into five groups: <18.5, 18.5 to 22.9, 23.0 to 24.9 (the reference category), 25.0 to 29.9, and ≥30.0 kg/m².</p><p>Results</p><p>The median BMI was 22.6 (IQR 20.3 to 25.1). The percentages of patients with BMI<18.5, 18.5 to 22.9, 23.0 to 24.9, 25.0 to 29.9, and ≥30.0 were 12, 42.3, 19.9, 22.4, and 3.3%, respectively. The Cox-proportional hazard ratios with exact partial likelihood to handle tied failures for hospital mortality comparing the BMI categories <18.5, 18.5 to 22.9, 25.0 to 29.9, and ≥30.0 with the reference category were 1.13 (0.88 to 1.44), 1.03 (0.84 to 1.26), 0.96 (0.76 to 1.22), and 0.68 (0.43 to 1.08), respectively, with a highly significant test for trend (<i>p</i> = 0.02).</p><p>Conclusions</p><p>A graded inverse association between BMI and hospital mortality with a strong significant trend was found in critically ill patients in Korea.</p></div

Severity and outcomes according to body mass index.

<p>Continuous variables are presented as medians (interquartile ranges).</p><p>Categorical variables are presented as frequencies (%).</p><p>SAPS, simplified acute physiology score; PDR, predicted death rate; SOFA, sequential organ failure assessment; ICU, intensive care unit; LOS, length of stay; MV, mechanical ventilation; CRRT, continuous renal replacement therapy.</p

Cox-proportional hazard ratios with exact partial likelihood and 95% confidence intervals for hospital mortality according to body mass index categories.

<p>Categorical variables are presented as frequencies (%).</p><p>HR, hazard ratio; CI, confidence interval.</p><p>*Adjusted for age, sex, SOFA, CPF, DM, cancer, severe sepsis or septic shock at ICU admission, ARDS at ICU admission, admission category, use of CRRT, mechanical ventilation, and use of vasopressors.</p>†<p>Adjusted age, sex, SOFA, DM, cancer, severe sepsis or septic shock at ICU admission, ARDS at ICU admission, admission category, use of CRRT, mechanical ventilation, and use of vasopressors.</p>§<p>Adjusted age, sex, SOFA, cirrhosis, CPF, cancer, severe sepsis or septic shock at ICU admission, ARDS at ICU admission, admission category, use of CRRT, mechanical ventilation, and use of vasopressors.</p>‡<p>Adjusted age, sex, SOFA, cirrhosis, cancer, severe sepsis or septic shock at ICU admission, ARDS at ICU admission, use of CRRT, mechanical ventilation, and use of vasopressors.</p>#<p>Adjusted age, sex, SOFA, cirrhosis, CPF, cancer, severe sepsis or septic shock at ICU admission, ARDS at ICU admission, use of CRRT, mechanical ventilation, and use of vasopressors.</p

Multivariable-adjusted Cox-proportional hazard ratios with exact partial likelihood for hospital mortality comparing body mass index categories.

<p>Multivariable adjusted Cox-proportional hazard ratios with exact partial likelihood and 95% confidence intervals are shown in this figure, illustrating a graded inverse association between BMI and hospital mortality with a strong significant trend (<i>p</i> = 0.02).</p