Accuracy of Narrow-Band Imaging Bronchoscopy for Early Diagnosis of Airway Cancer Lesions: A Systematic Review and Meta-analysis

Context: The accuracy of narrow-band imaging (NBI) is a technology imaging for the assessment of lung cancer. Objectives: We aimed at summarizing the diagnostic profile of NBI for the early diagnosis of airway cancer lesions. Methods:We used PubMed, Scopus, and EMBASE databases to search for eligible studies published up to October 2022. Eligible studies have investigated the diagnostic profile of bronchoscopy NBI for the early diagnosis of lung cancer. The index test was NBI bronchoscopy, and the reference test was the histopathological results of lung cancer based on the World Health Organization (WHO) classification. In eligible studies, the detected lesions were confirmed by histopathology. We extracted true positive (TP), true negative (TN), false positive (FP), and false negative (FN) from the eligible studies to calculate the diagnostic profile of NBI. the quality assessment of diagnostic accuracy studies-2 (QUADAS-2) assessment was used as a tool to assess the risk of bias. A random-effects model was used to pool the summary receiver operating characteristic curve, specificity, and sensitivity. Results: Five studies were included, involving 1267 subjects with 1850 biopsy specimens. The overall pooled sensitivity and specificity for NBI bronchoscopy for the early detection of airway cancer lesions were 98% (95% confidence interval [CI]: 89% - 100%) and 77% (95% CI: 62% - 88%), respectively. All I2 values for sensitivity and specificity were 35.93% and 85%, respectively, with a P-value of 0.001. The positive LR was 4.35 (95% CI: 2.51 - 7.54, P < 0.001), and the negative LR was 0.03 (95% CI: 0.01 - 0.14, P = 0.006). The area under the receiver operating characteristic curve was 0.95 (95% CI: 0.92 - 0.96). Conclusions: Narrow-band imaging bronchoscopy can be used as a diagnostic modality for the early diagnosis of airway cancer lesions with good diagnostic accuracy.