Abstract
Currently, whether endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is superior to conventional TBNA (cTBNA) in the diagnosis of mediastinal lymphadenopathy remains controversial. We undertook a meta-analysis of randomized controlled trials (RCTs) to evaluate the diagnostic yield of EBUS-TBNA versus cTBNA in the diagnosis of mediastinal lymphadenopathy, both in benign and malignant etiologies. Computer-based retrieval was performed on PubMed and EMBASE. The quality was evaluated according to the quality assessment of diagnostic accuracy studies-2, and Meta-Disc was adopted to perform meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95 % confidence intervals (CIs) were calculated. The summary receiving operating characteristic curve as well as the areas under curve (AUC) was measured. Four studies with a total of 440 patients met the inclusion criteria. Our results showed that the pooled sensitivity was 0.90 (95 % CI 0.85–0.94) and 0.76 (95 % CI 0.68–0.82), pooled specificity was 0.75 (95 % CI 0.60–0.87) and 0.94 (95 % CI 0.86–0.98), DOR was 75.38 (95 % CI 16.38–346.97) and 108.17 (95 % CI 13.84–845.35), and AUC was 0.9339 and 0.9732 for EBUS-TBNA group and cTBNA group, respectively. Although EBUS-TBNA with a higher sensitivity performs better than cTBNA, there is lack of enough evidence regarding EBUS-TBNA being superior to cTBNA in the diagnosis of mediastinal lymphadenopathy. Considering the limitations of methodology and limited data, further robust RCTs are needed to verify the current findings and investigate the optimal choice in patients receiving TBNA.
Highlights
Mediastinal lymphadenopathy include a variety of benign and malignant conditions, such as lung cancer and sarcoidosis, which are depended on the pathology in terms of the gold standard for diagnosis
The following selection criteria were included: (1) population: consecutive patients with mediastinal lymphadenopathy undergoing transbronchial needle aspiration (TBNA); (2) study design: randomized controlled trials (RCTs) comparing the diagnostic value of real time endobronchial ultrasound-guided (EBUS)-TBNA versus conventional TBNA (cTBNA) in the detection of mediastinal lymphadenopathy; (3) sufficient data: reported data allowing calculation of the true-positive (TP), falsepositive (FP), false-negative (FN) and true negative (TN) values; and (4) reference standard: histopathological and/ or cytological analysis, or close radiological and clinical follow up for at least 6 months after TBNA, as the reference standard
The results of our study indicated that both EBUS-TBNA and cTBNA are safe and provide good diagnostic value for patients with mediastinal lymphadenopathy
Summary
Mediastinal lymphadenopathy include a variety of benign and malignant conditions, such as lung cancer and sarcoidosis, which are depended on the pathology in terms of the gold standard for diagnosis. Several studies showed that EBUS-TBNA has high sensitivity, specificity and safety in the diagnosis of sarcoidosis and staging of lung cancer (Adams et al 2009; Gu et al 2009; Varela-Lema et al 2009; Yang et al 2014; Trisolini et al 2015). Other studies suggested that EBUS-TBNA was not superior to cTBNA in lung cancer patients with mediastinal nodes real-time sampling (Bellinger et al 2012; Jiang et al 2014). The diagnostic yield of EBUS-TBNA versus cTBNA in mediastinal lymphadenopathy has not yet been well established. We pre-stated rigorous inclusion criteria and enrolled available randomized controlled trials (RCTs) combining EBUS-TBNA and cTBNA to critically assess the diagnostic yield of EBUSTBNA versus cTBNA in the diagnosis of mediastinal lymphadenopathy
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