Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 5 appraisals
European respiratory review : an official journal of the European Respiratory Society
Yield and safety of different biopsy types in interstitial lung disease: a systematic review and meta-analysis
BACKGROUND: Lung biopsy remains an important consideration in the management of interstitial lung disease (ILD). Transbronchial lung cryobiopsy (TBLC) offers an alternative to traditional surgical lung biopsy (SLB) and transbronchial forceps biopsy (TBB); however, up-to-date comparisons between these methods in ILD, particularly fibrotic ILD, remain limited. METHODS: A comprehensive literature search of Medline, Embase and Evidence-Based Medicine Reviews was performed for studies published between January 2000 and September 2025 to identify all citations reporting yield and complications of the three main lung biopsy methods for ILD. RESULTS: A total of 143 studies were included. Pooled multidisciplinary yield (following multidisciplinary discussion) in TBB, TBLC and SLB was 35.3% (95% CI 21.3-52.5), 84.3% (95% CI 81.7-86.5) and 88.6% (95% CI 83.4-92.3), respectively. For fibrotic ILD, the multidisciplinary yield was 12.5% (only one eligible study), 87.6% (95% CI 83.5-90.7) and 87.3% (95%CI 80.5-92.0), respectively. Meta-regression showed an increasing multidisciplinary yield of TBLC with more recent years of patient recruitment and an increasing percentage of fibrotic ILD in each study. The multidisciplinary yield of both TBLC and SLB was 85-90%, suggesting a biopsy "ceiling effect". All evaluated complications were more frequent in TBLC compared to TBB and some were more frequent in SLB compared to TBLC. Several complications were more frequent in fibrotic ILD compared to all ILD. CONCLUSIONS: The multidisciplinary yield of TBLC and SLB is equivalent, with both offering an acceptable safety profile. TBB has low yield, particularly in fibrotic ILD. These findings support using either TBLC or SLB as an initial diagnostic tool in fibrotic ILD, mainly based on patient-physician shared decision-making.
15 May 2026
Read appraisal →Journal of bronchology & interventional pulmonology
AIBAN-AI Bronchial Detection and Airway Navigation System
BACKGROUND: Accurate navigation within the lungs is critical for bronchoscopy procedures but remains challenging due to the complex airway anatomy. Artificial intelligence (AI) integrating real-time landmark detection and navigation guidance may enhance precision and safety. METHODS: We developed an AI Bronchial detection and Airway Navigation system (AIBAN) for bronchoscopy, combining airway lumen detection, anatomic localization, and navigation guidance. A YOLOv8-based detection module was used to identify 34 airway landmarks in real time. Next, an airway-level localization module estimated the bronchoscope's position using a hierarchical anatomic graph, identifying the deepest branch compatible with all coherent detections in each frame. A navigation module then recommended the next airway to follow along predefined anatomic paths, providing directional cues to perform a complete and systematic bronchoscopy. RESULTS: AIBAN was developed on a data set of 18 bronchoscopy videos, using 15 for training and 3 for validation. In validation, the framework correctly identified the bronchoscope's location in 91.1% of the frames. In addition, 92.6% of predictions were within one airway branch of the true location, and 94.5% were within 2 branches. The navigation guidance performance was also promising, with the system following the correct anatomic pathway in 96.2% of test videos, demonstrating reliable guidance through the lungs. CONCLUSION: AIBAN enables accurate airway detection, localization, and navigation guidance in a simulation-based setting. It can provide reliable guidance along predefined paths and precise spatial positioning and is a promising tool for medical training and has potential for future clinical implementation.
11 May 2026
Read appraisal →Thorax
Digital twin-based bronchoscopy simulator improves training performance and skill retention of novices: a randomised controlled study
RATIONALE: Conventional bronchoscopy training often does not ensure lasting skill retention or adaptability to different anatomies, limiting real-world impact. This study used a digital-twin bronchoscopy simulator with various CT-derived bronchial tree models to better train novices. OBJECTIVES: To explore training with various anatomically diverse bronchial tree models in novices' bronchoscopy performance. METHODS: 60 bronchoscopy-naive participants were randomly assigned to three groups (n=20 each): control (written instruction only), anatomic-uniformity (trained on one standard bronchial model) and anatomic-variety (trained on multiple patient-derived bronchial models). All participants performed two tests: test 1 on a standard model and test 2 on a new CT-derived model. Both tests were repeated 3 months later to assess skill retention. The primary comparison was between the anatomic-variety and anatomic-uniformity groups. MEASUREMENTS AND MAIN RESULTS: 60 participants completed tests 1 and 2. 55 returned at 3 months. In test 1, there were no significant differences between the anatomic-variety and anatomic-uniformity groups in diagnostic completeness (DC, 0 segments, p=0.576), structured progress (SP, 1 correct progression, p=0.091) and procedure time (31 s, p=0.831). In test 2, the anatomic-variety group had significantly higher DC (2.5 segments, p<0.001) and SP (9 progression, p<0.001) than the anatomic-uniformity group. At 3 months, the anatomic-variety group retained superior DC and SP scores in both tests despite slight declines. CONCLUSIONS: Training with diverse anatomical models significantly enhanced bronchoscopy performance compared with repetitive practice on a single standardised model with partially maintained learning gains at 3 months.
17 Apr 2026
Read appraisal →Pulmonology
Comparative diagnostic performance of advanced endoscopic techniques in suspected sarcoidosis: A systematic review and network meta-analysis
BACKGROUND: While various endoscopic techniques are used for minimally invasive tissue sampling in suspected sarcoidosis, comprehensive evidence comparing their diagnostic efficacy is limited, and the optimal approach remains unclear. RESEARCH QUESTION: Which endoscopic technique provides the greatest diagnostic advantage for sarcoidosis? STUDY DESIGN AND METHODS: We systematically searched 3 databases for studies published up to 22 April 2025. A network meta-analysis was conducted within a Bayesian framework, with diagnostic yield as the primary outcome. RESULTS: A total of 35 studies were included. Compared to TBLB, both EBUS-guided intranodal forceps biopsy (EBUS-IFB) (RR 3.50, 2.14-5.84) and EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) (RR 3.52, 1.97-6.48) showed higher diagnostic yield. SUCRA rankings placed EBUS-IFB (0.912) and EBUS-TMC (0.910) at the top, followed by EBUS-guided core needle biopsy (EBUS-CNB) (0.587), EUS-FNA (0.582), and EBUS-TBNA (0.560), EUS-B-FNA (0.498). Conventional techniques, including cTBNA (0.279), TBLB (0.168), and EBB (0.001), ranked lowest. All procedures had a favourable safety profile. CONCLUSIONS: In centres with appropriate expertise, EBUS-IFB and EBUS-TMC may offer superior diagnostic performance for sarcoidosis. However, given the low certainty of evidence, these conclusions should be interpreted with caution. Clinical decisions should be individualised, considering the patient's condition when determining the final diagnostic strategy.
8 Apr 2026
Read appraisal →Curr Opin Pulm Med
Foreign body removal
PURPOSE OF REVIEW: Airway foreign body aspiration remains a potentially life-threatening emergency, predominantly affecting children under 5 years and adults over 65 years. This review synthesizes current evidence on diagnostic strategies, bronchoscopic extraction techniques, procedural outcomes, complication management, and emerging technologies in airway foreign body management. RECENT FINDINGS: Multidetector computed tomography with three-dimensional reconstruction has significantly improved diagnostic accuracy, achieving sensitivity of 98-99% for radiopaque objects and 85-92% for radiolucent materials. Flexible bronchoscopy has evolved from a diagnostic tool to a first-line therapeutic modality, with recent pediatric meta-analyses demonstrating 87% success rates and adult series showing comparable outcomes to rigid bronchoscopy for appropriately selected cases. Rigid bronchoscopy maintains superiority in asphyxiating presentations, and for large (>1.5 cm), sharp, or severely impacted foreign bodies. Technological innovations including robotic-assisted bronchoscopy, electromagnetic navigation systems, and artificial intelligence-powered imaging analysis are enhancing procedural precision and safety. SUMMARY: Successful airway foreign body management requires individualized, multidisciplinary approaches integrating patient clinical status, foreign body characteristics, and institutional expertise. Success depends on appropriate bronchoscopic modality selection, comprehensive preprocedural planning, availability of specialized retrieval instruments, and readiness to manage potential complications. Integration of advanced imaging, simulation-based training protocols, and telemedicine consultation are becoming essential components of contemporary practice.
1 Jan 2026
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