Computed Tomography-Guided Lung Biopsy for Molecular Tests: A Meta-Analysis

Background To evaluate the potential clinical effectiveness of computed tomography (CT)-guided lung biopsy in the molecular tests. Materials and Methods We searched the related studies from the PubMed, Embase, and Cochrane Library until July 2021. The endpoints included adequacy rates for molecular tests, positive rates of epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK) translocation, and Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations. Results Initially, we were able to identify 1783 potentially relevant studies among which, only 12 were ultimately included in the present meta-analysis. All the studies were retrospective in nature. A total of 2559 patients underwent CT-guided lung biopsy and 1414 of them received molecular testing. We found that pooled adequacy rate for molecular tests, positive rate of EGFR mutations, and positive rate of ALK translocation were 95% (95% CI: 0.93–0.98), 49% (95% CI: 0.42–0.56), and 7% (95% CI: 0.04–0.09), respectively. Moreover, only 1 article reported the positive rate of KRAS mutation of 6% but a significant heterogeneity was detected in the endpoints of adequacy rate for molecular tests (I2 = 86.2%, P < 0.001) and positive rate of EGFR mutations (I2 = 77.7%, P < 0.001). While conducting a meta-regression analysis, we did not identify any variables that could significantly influence adequacy rate for molecular tests and positive rate of EGFR mutations. A high risk of publication bias was also found in the endpoint of adequacy rate for molecular tests (Egger test: P = 0.043). Conclusions CT-guided lung biopsy can serve as an effective method to provide sufficient lung cancer samples for molecular testing. EGFR gene was found to be the most frequently mutated during the analysis.