• André Miotto, PerfeitoJoão Aléssio JulianoJAJ0000-0001-5958-2541MD, PhD. Thoracic Surgeon, Associate Professor, Thoracic Surgery Division, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil., Rafael Leite Pacheco, Carolina de Oliveira Cruz Latorraca, and Rachel Riera.
• IMD, PhD. Thoracic Surgeon, Assistant Professor, Thoracic Surgery Division, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
• Sao Paulo Med J. 2023 Jan 1; 141 (5): e2022543e2022543.

BackgroundImaging tests are important for diagnosis during the management of pulmonary nodules; however, biopsy is required to confirm the malignancy.ObjectivesTo compare the effects of different techniques used for the biopsy of a pulmonary nodule.Design And SettingSystematic review and meta-analysis were conducted using Cochrane methodology in São Paulo, São Paulo, Brazil.MethodsWe conducted a systematic review of randomized controlled trials (RCTs) on minimally invasive techniques, including tomography-guided percutaneous biopsy (PERCUT), transbronchial biopsies with fluoroscopy (FLUOR), endobronchial ultrasound (EBUSR), and electromagnetic navigation (NAVIG). The primary outcomes were diagnostic yield, major adverse events, and need for another approach.ResultsSeven RCTs were included (913 participants; 39.2% female, mean age: 59.28 years). Little to no increase was observed in PERCUT over FLUOR (P = 0.84), PERCUT over EBUSR (P = 0.32), and EBUSR over NAVIG (P = 0.17), whereas a slight increase was observed in NAVIG over FLUOR (P = 0.17); however, the evidence was uncertain. EBUSR may increase the diagnostic yield over FLUOR (P = 0.34). PERCUT showed little to no increase in all bronchoscopic techniques, with uncertain evidence (P = 0.02).ConclusionNo biopsy method is definitively superior to others. The preferred approach must consider availability, accessibility, and cost, as safety and diagnostic yield do not differ. Further RCTs planned, conducted, and reported with methodological rigor and transparency are needed, and additional studies should assess cost and the correlation between nodule size and location, as well as their association with biopsy results.Systematic Review RegistrationPROSPERO database, CRD42018092367 -https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=92367.

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