Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA.
Respir Care. 2012 Mar;57(3):384-91. doi: 10.4187/respcare.01274. Epub 2011 Oct 12.
To perform a systematic review and meta-analysis of prospectively conducted studies to define diagnostic performance of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNB) in mediastinal and hilar lymphadenopathy.
A comprehensive search was performed using the Embase, Ovid Medline, Ovid Medline In-Process and Other Non-Indexed Citations, All Evidence Based Medicine Reviews-Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CCTR), Health Technology Assessment (HTA), and SCOPUS databases, in the second week of November 2010. Studies were selected in 2 phases by 2 reviewers, independently. Data extraction from each study was performed using a standardized data extraction form. Quality assessment of study methodology was done using a checklist that was developed based on a Quality Assessment of Diagnostic Accuracy Studies tool and the nature of the test. Using the 2 × 2 tables, we computed the sensitivity, specificity, and likelihood ratios.
The 14 studies included for quantitative data synthesis had a pooled cohort of 1,658 patients, from 8 different countries. The EBUS-TBNB had excellent pooled specificity of 100% (95% CI 0.90-1.00) and a positive likelihood ratio of 5.1 (95% CI 2.7-9.7). The pooled sensitivity was 0.92 (95% CI 0.91-0.93), and the pooled negative likelihood ratio was 0.13 (95% CI 0.09-0.19). The sensitivity of this intervention was not dependent on rapid on-site evaluation use or size of needle used. The pooled diagnostic odds ratio was 62.7 (95% CI 25.7-153.0). Only one major complication was reported, which resulted in early termination of the procedure.
Evidence of moderate quality confirms the high diagnostic performance of EBUS-TBNB for mediastinal and hilar lymphadenopathy, both in malignant and non-malignant conditions. Available evidence also demonstrates the safety of this procedure.
系统评价前瞻性研究，以明确经支气管超声引导针吸活检（EBUS-TBNA）在纵隔和肺门淋巴结病变中的诊断性能。
2010 年 11 月第二周，使用 Embase、Ovid Medline、Ovid Medline In-Process 和其他非索引引文、所有循证医学评价- Cochrane 系统评价数据库、美国医师学会杂志俱乐部、疗效评价文摘数据库（DARE）、Cochrane 对照试验中心注册库（CCTR）、卫生技术评估（HTA）和 Scopus 数据库进行全面检索。由 2 名评审员分 2 阶段独立选择研究。使用标准化数据提取表从每项研究中提取数据。使用根据诊断准确性研究工具和测试性质制定的检查表对研究方法的质量进行评估。使用 2×2 表计算敏感性、特异性和似然比。
纳入定量数据分析的 14 项研究共纳入来自 8 个国家的 1658 例患者。EBUS-TBNA 具有出色的综合特异性（100%）（95%CI：0.90-1.00）和阳性似然比（5.1）（95%CI：2.7-9.7）。综合敏感性为 0.92（95%CI：0.91-0.93），综合阴性似然比为 0.13（95%CI：0.09-0.19）。该干预措施的敏感性与快速现场评估的使用或使用的针的大小无关。综合诊断优势比为 62.7（95%CI：25.7-153.0）。仅报告了 1 例严重并发症，导致该操作提前终止。
中等质量的证据证实，EBUS-TBNA 对纵隔和肺门淋巴结病变具有较高的诊断性能，无论是在恶性还是非恶性情况下。现有证据还表明该操作是安全的。
