在患有周围性肺部病变（PPL）的患者中，非诊断性支气管镜检查的结果并不少见。支气管镜检查后估计癌症概率 (pCA) 的传统方法依赖于二分法测试假设，利用患病率、敏感性和特异性来确定阴性预测值 (NPV)。然而，支气管镜检查是一种多疾病测试，引起了人们对二分法准确性的担忧。当应用于支气管镜检查等多疾病测试来诊断 PPL 时，使用二分法 (pCAdichotomous) 计算 pCA 在多大程度上低估了真实的 pCA ?涉及用于 PPL 的径向 EBUS 的队列研究的荟萃分析。遵循 PRISMA 指南，构建 2×2 列联表来计算 pCAdichotomous。对于多疾病测试方法，使用用于非诊断结果LR(T0)的似然比方法计算pCA多疾病的3×3列联表。将观察到的非诊断结果患者的恶性肿瘤率与 pCA 二分法和 pCA 多疾病患者进行比较。 在 46 项研究（7506 名患者）中，76% 的基础诊断为恶性肿瘤，13% 为其他特定疾病，非特异性纤维化/疤痕10%。在所有研究中，具有非诊断结果的恶性肿瘤患者的百分比与 pCA 多种疾病相匹配。相比之下，pCAdichotomous 始终低估癌症风险（中位数差异：0.12，第 25-75 个百分位数：0.06-0.23），特别是在非恶性疾病患病率较高的研究中。合并的 LR(T0) 为 0.46（95% CI 0.40-0.52，I2 76%，p<0.001），并且与非恶性疾病的患病率相关（p=0.001）。用于估计非恶性疾病后 pCA 的传统二分法诊断性支气管镜检查低估了恶性肿瘤的可能性。医生在解释支气管镜检查结果时应选择多疾病测试方法。版权所有 © 2024。由 Elsevier Inc. 出版。

In patients with peripheral pulmonary lesions (PPL), non-diagnostic bronchoscopy, results are not uncommon. The conventional approach to estimate the probability of cancer (pCA) following bronchoscopies relies on dichotomous test assumptions, utilizing prevalence, sensitivity, and specificity to determine negative predictive value (NPV). However, bronchoscopy is a multi-disease test, raising concerns about the accuracy of dichotomous methodologies.By how much does calculating pCA using a dichotomous approach (pCAdichotomous) underestimate the true pCA when applied to multi-disease tests like bronchoscopy for the diagnosis of PPL?Meta-analysis of cohort studies involving radial-EBUS for PPL. PRISMA guidelines were followed, constructing 2×2 contingency tables for calculating pCAdichotomous. For the multi-disease test approach, 3×3 contingency tables for calculating pCAmulti-disease using the likelihood ratio method for non-diagnostic results LR(T0) was used. Observed malignancy rates in patients with non-diagnostic results were compared to pCAdichotomous and pCAmulti-disease.In 46 studies (7506 patients), malignancy was the underlying diagnosis in 76%, another specific disease in 13%, and non-specific fibrosis/scar in 10%. The percentage of patients with non-diagnostic results who had malignancy matched pCAmulti-disease across all studies. In contrast, pCAdichotomous consistently underestimated cancer risk (median difference: 0.12, 25th-75th percentile: 0.06-0.23), particularly in studies with a higher prevalence of non-malignant disease. The pooled LR(T0) was 0.46 (95% CI 0.40-0.52, I2 76%, p<0.001), and correlated with the prevalence of non-malignant diseases (p=0.001).Conventional dichotomous methods for estimating pCA after non-diagnostic bronchoscopies underestimate the likelihood of malignancy. Physicians should opt for the multi-disease test approach when interpreting bronchoscopy results.Copyright © 2024. Published by Elsevier Inc.