Efficacy of CEUS-guided biopsy for thoracic and pulmonary lesions: a systematic review and meta-analysis

BackgroundThis study compares the success rate, diagnostic accuracy, and safety of contrast-enhanced ultrasound (CEUS)-guided biopsy versus conventional ultrasound (US)-guided biopsy for thoracic and pulmonary lesions.MethodsA systematic search of PubMed, EMBASE, Web of Science, and Cochrane Library was conducted. The primary outcomes included success rate and diagnostic accuracy, and the secondary outcome was the odds ratio of adverse effects. A random-effects meta-analysis pooled the data, with heterogeneity assessed by I-2 and publication bias evaluated using Egger's test and funnel plot analysis. Sensitivity analysis was performed to confirm result robustness. Subgroup analysis and meta-regression were conducted to explore the sources of heterogeneity.ResultsSixteen studies with 3,459 patients were included. CEUS-guided biopsy demonstrated higher success rate (99.18%, 95% CI: 98.00-99.90%) and diagnostic accuracy (95.96%, 95% CI: 94.84-96.96%) than US-guided biopsy (success rate: 97.26%, 95% CI: 95.45-98.68%; diagnostic accuracy: 85.87%, 95% CI: 82.05-89.31%). Complications were more frequent in the US-guided group, with an odds ratio of 1.65 (95% CI: 1.15-2.37). Heterogeneity was low, and publication bias was minimal, except for diagnostic accuracy in the US group. Sensitivity analysis confirmed result robustness.ConclusionCompared with conventional ultrasound, CEUS-guided biopsy demonstrates a comparable success rate, superior diagnostic accuracy, and a lower incidence of complications, underscoring its clinical value as a preferred approach for thoracic and pulmonary lesion assessment.Systematic review registrationThis study was registered with PROSPERO under the registration number CRD42024608627.Clinical trial numberNot applicable.