Abstract
The present systematic review and meta-analysis aimed to evaluate the available evidence base on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) combined with either endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or endoscopic ultrasound using the EBUS scope-guided fine-needle aspiration (EUS-B-FNA) for diagnosing and staging mediastinal diseases.PubMed, Web of Science, and Embase were searched to identify suitable studies up to June 30, 2019. Two investigators independently reviewed articles and extracted relevant data. Data were pooled using random effect models to calculate diagnostic indices that included sensitivity and specificity. Summary receiver operating characteristic (SROC) curves were used to summarize the overall test performance.Data pooled from up to 16 eligible studies (including 10 studies of 963 patients about EBUS-TBNA with EUS-FNA and six studies of 815 patients with EUS-B-FNA) indicated that combining EBUS-TBNA with EUS-FNA was associated with slightly better diagnostic accuracy than combining it with EUS-B-FNA, in terms of sensitivity (0.87, 95%CI 0.83 to 0.90 vs. 0.84, 95%CI 0.80 to 0.88), specificity (1.00, 95%CI 0.99 to 1.00 vs. 0.96, 95%CI 0.93 to 0.97), diagnostic odds ratio (413.39, 95%CI 179.99 to 949.48 vs. 256.38, 95%CI 45.48 to 1445.32), and area under the SROC curve (0.99, 95%CI 0.97 to 1.00 vs. 0.97, 95%CI 0.92 to 1.00).The current evidence suggests that the combination of EBUS-TBNA with either EUS-FNA or EUS-B-FNA provides relatively high accuracy for diagnosing mediastinal diseases. The combination with EUS-FNA may be slightly better.
Highlights
Mediastinal diseases can be caused by lung cancer, tuberculosis, sarcoidosis, inflammation, and other malignant tumors [1]
To evaluate which method is better to combine with EBUSTBNA and to provide a reference for clinical work, we searched PubMed, Web of Science, and Embase for studies that were published from January 2005 to July 2019 and that evaluated the accuracy of EBUS-TBNA combined with EUSFNA or EUS-B-FNA for diagnosing and staging mediastinal diseases
We included 16 studies involving 1,778 patients who were diagnosed with mediastinal diseases based on the combination of EBUS-TBNA with endoscopy ultrasoundguided fine-needle aspiration (EUS-FNA) (10 studies, 963 patients) or EUS-B-FNA (Table 1)
Summary
Mediastinal diseases can be caused by lung cancer, tuberculosis, sarcoidosis, inflammation, and other malignant tumors [1]. Important minimally invasive methods for achieving this are endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopy ultrasoundguided fine-needle aspiration (EUS-FNA), and combining the two is attractive because together they can cover nearly the entire mediastinum [2,3,4,5]. The combination of EBUS-TBNA and EUS-B-FNA can cover nearly the complete mediastinum and can be performed by one doctor using a single endoscope. International lung cancer staging guidelines recommend EBUS-TBNA combined with either EUSFNA or EUS-B-FNA for diagnosing and staging mediastinal diseases [8,9,10]
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