Figures
- FIGURE 1
Study selection algorithm. Results of search and study selection algorithm for sensitivity and complication rates of a) thoracentesis and b) thoracoscopy.
- FIGURE 2
Forest plot: sensitivity of thoracentesis. Pooled estimate for sensitivity (ES) of thoracentesis for malignant pleural effusion secondary to any malignancy. TP: true positives; FN: false negatives.
- FIGURE 3
Forest plots: sensitivity of thoracentesis by cancer type. Sensitivity of thoracentesis for malignant pleural effusion secondary to a) mesothelioma, b) lung cancer and c) breast cancer. ES: estimated sensitivity; TP: true positives; FN: false negatives.
- FIGURE 4
Forest plot: sensitivity of thoracoscopy for malignant pleural effusion secondary to any malignancy. ES: estimated sensitivity; TP: true positives; FN: false negatives.
- FIGURE 5
Forest plot: sensitivity of thoracoscopy by cancer type. Sensitivity of thoracoscopy for malignant pleural effusion secondary to mesothelioma. ES: estimated sensitivity; TP: true positives; FN: false negatives.
Tables
- TABLE 1
Meta-analyses for sensitivity of thoracentesis and thoracoscopy
Studies (n) Patients in the studies (n) Patients included in the sensitivity analysis (n) Pooled sensitivity (95% CI) I2 statistic# (%) Within-strata heterogeneity p-value sROC-AUC (95% CI) Test of heterogeneity between groups¶ p-value Meta-regression¶ p-value Thoracentesis Primary meta-analysis of sensitivity for MPE secondary to any malignancy 29 11 952 5444 0.643 (0.592–0.692) 92.302 <0.001 0.85 (0.82–0.88) Year of publication 0.779 Prevalence of MPE 0.820 Secondary meta-analysis of sensitivity for MPE secondary to mesothelioma 8 8565 1133 0.451 (0.249–0.661) 97.52 <0.001 0.86 (0.82–0.89) Secondary meta-analysis of sensitivity for MPE secondary to lung cancer 12 6267 1184 0.738 (0.648–0.819) 89.505 <0.001 0.99 (0.97–0.99) Secondary meta-analysis of sensitivity for MPE secondary to breast cancer 9 5620 532 0.820 (0.700–0.917) 88.668 <0.001 1.0 (0.98–1.00) Thoracoscopy Primary meta-analysis of sensitivity for MPE secondary to any malignancy 41 5652 2963 0.929 (0.905–0.95) 75.79 <0.001 0.99 (0.98–1.00) Year of publication 0.510 Prevalence of MPE 0.753 Thoracoscope used 0.824 Rigid 21 2666 0.929 (0.908–0.948) 41.80 0.024 Semi-rigid 15 2521 0.931 (0.88–0.971) 84.88 <0.001 Rigid and semi-rigid 4 348 0.906 (0.819–0.969) 63.90 0.040 Anaesthesia used 0.928 General anaesthesia 3 240 0.917(0.735–1.00) <0.001 Local anaesthesia 4 568 0.931 (0.905–0.954) 76.34 <0.001 General and local anaesthesia 34 4844 0.920 (0.879–0.954) 28.89 <0.001 Secondary meta-analysis of sensitivity for MPE secondary to mesothelioma 15 1400 453 0.915 (0.871–0.952) 48.79 0.017 0.90 (0.94–0.97 Secondary meta-analysis of sensitivity for MPE secondary to lung cancer+ 1 48 Secondary meta-analysis of sensitivity for MPE secondary to breast cancer+ Sensitivities are reported by patient. sROC: summary receiver operating characteristic; AUC: area under the curve; MPE: malignant pleural effusions. #: the I2 statistic describes the percentage of total variation across studies due to heterogeneity between studies rather than chance. A value >75% is considered as major heterogeneity and a value <40% is considered insufficient to prove heterogeneity [19]; ¶: causes of heterogeneity between groups and meta-regressions are only reported for the combined analysis given the very few studies included in the stratified analysis that limit the power of the tests; +: a pooled estimate could not be calculated given that only one study with >10 patients with MPE reported sensitivity of thoracoscopy for MPE secondary to lung cancer and breast cancer.
- TABLE 2
Meta-analysis results for complication rate of thoracentesis and thoracoscopy, and pneumothorax rate of thoracentesis
Studies (n) Procedures (n) Pool-complication rate (95% CI) I2 statistic (%)# Within-study heterogeneity p-value Test of heterogeneity within groups (p-value) Meta-regression p-value Thoracentesis Complication rate 23 32863 0.041 (0.025–0.061) 97.318 <0.001 Year of publication 0.174 Pneumothorax rate 36 66359 0.025 (0.017–0.034) 96.070 <0.001 Year of publication 0.855 Complications other than pneumothorax 22 32578 0.015 (0.009–0.023) 89.55 <0.001 Year of publication 0.137 Thoracoscopy Complication rate per procedure 79 15139 0.040 (0.029–0.052) 85.910 <0.001 Year of publication 0.116 Thoracoscope used 0.992 Rigid 33 2862 0.042 (0.023–0.066) 83.86 <0.001 Semi-rigid 30 3231 0.040 (0.020–0.064) 84.79 <0.001 Rigid and semi-rigid 9 1831 0.043 (0.01–0.091) 92.29 <0.001 Anaesthesia used 0.150 General anaesthesia 12 969 0.016 (0.001–0.042) 73.87 <0.001 Local anaesthesia 63 7258 0.045 (0.031–0.061) 86.00 <0.001 General and local anaesthesia 2 211 0.054 (0.025–0.090) <0.001 All complications are reported by procedure. Meta-regression on prevalence was not made given that most studies reporting complications did not report results on sensitivity and prevalence of malignant pleural effusion. #: the I2 statistic describes the percentage of total variation across studies due to heterogeneity between studies rather than chance. A value >75% is considered as major heterogeneity and a value <40% is considered insufficient to prove heterogeneity [19].
Supplementary Material
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Supplementary material ERR-0053-2022.SUPPLEMENT
