Eleven studies met the inclusion criteria: four studies were prospective, four retrospective and the direction of data collection was not reported in the other three. Ten of the 11 studies had an acceptable reference standard, avoided partial verification, incorporation and clinical review biases and reported uninterpretable results; six recruited exclusively patients with lung lesions; five, in which it was considered applicable, avoided progression bias; none avoided differential verification bias; four reported blinding investigators for the index test; and eight explained withdrawals. Overall, the quality of the eligible studies was considered to be poor.
When distinguishing between benign and malignant lesions (based on three out of five studies, 792 participants) sensitivity of fine-needle aspiration biopsy ranged from 81.3% to 90.8%, specificity from 75.4% to 100%, LR+ from 3.67 to 45.46, LR- from 0.10 to 0.18, and overall accuracy from 79.7% to 91.8%. Sensitivity of core-needle biopsy ranged from 85.7 to 97.4%, specificity from 88.6% to 100%, LR+ from 7.79 to 75.94, LR- from 0.03 to 0.12, and overall accuracy from 89.0% to 96.9%.
For identifying the histologic subtype of malignancies or the specific benign diagnoses (seven studies, 834 participants) sensitivity of fine-needle aspiration biopsy ranged from 56.3% to 86.5%, specificity from 6.7% to 57.1%, LR+ from 0.60–1.93, LR- from 0.30–6.56, and overall accuracy from 40.4% to 81.2%. Sensitivity of core-needle biopsy ranged from 56.5 to 88.7%, specificity from 52.4% to 100%, LR+ from 1.55 to 15.07, LR- from 0.12 to 0.50 and overall accuracy from 66.7% to 93.2%.
For direct comparisons of fine-needle and core-needle biopsy (five studies, 545 participants) accuracy ranged from 58.7% to 81.2% for fine-needle aspiration biopsy and 66.7% to 89.5% for core-needle biopsy; accuracy was significantly higher for fine-needle than for core-needle biopsy in two studies.
Overall there was no significant difference in the rate of pneumothorax or haemoptysis between fine-needle and core-needle biopsy (11 studies). Additional results were provided for studies that used CT (computed tomography) imaging (five studies), recruited only patients with lung lesions (four studies) or used an on-site cytopathologist (four studies).