Diagnostic yield and safety of non-intubated VATS vs VATS vs transbronchial lung cryobiopsy in interstitial lung diseases. A systematic review and meta-analysis.

Abstract

Background: Histology is required by about 30% of the Interstitial Lung Diseases (ILD) for a precise diagnosis. Surgical Lung Biopsy of two lobes through video-assisted thoracoscopic surgery (VATS) is considered the gold standard. However, significant morbidity and mortality have been reported as consequences of this intervention. In the last decade, Transbronchial Lung Cryobiopsy (TBLC) and more recently Awake VATS (AVATS) have arisen as safer alternatives. Objective: The purpose of this meta-analysis is to investigate the pooled diagnostic yield and safety profile for AVATS, and compare them to VATS and TBLC. Methods: A systematic search of the literature, from January 2010 to November 2022 was performed to find information regarding the diagnostic yield and safety of TBLC, VATS or AVATS for patients with suspected ILDs. A meta-analysis of proportions was conducted for the retrieved outcomes using random-effect models with Freeman-Tukey transformation. Results: 79 studies were included in this meta-analysis. AVATS had a pooled diagnostic yield of 98.8%, compared with 89.6% (histology) and 94.2% (MDD) from VATS, and 76.0% (histology) and 82.8% (MDD) from TBLC. As for safety, AVATS had a combined average incidence rate of acute exacerbation of 0% (95CI:0-0,5%) compared with 1.0% (95CI:0,4-1,8%) in VATS, and 0% (95CI:0-0,1%) in TBLC. Regarding mortality, the average incidence of 30-day mortality in the 3 procedures was 0% (95CI:0-0,6%) for AVATS, 0% (95CI:0-0,1%) for TBLC, and 0.4% (0-1,2%) for VATS. Conclusion: AVATS appears to be a viable and safe procedure with a high histopathological diagnostic yield comparable to VATS, and a similar safety profile to TBLC. However, due to the limited data published so far concerning AVATS, these results must be interpreted with caution.