Dhooria Sahajal, Aggarwal Ashutosh N, Gupta Dheeraj, Behera Digambar, Agarwal Ritesh
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Respir Care. 2015 Jul;60(7):1040-50. doi: 10.4187/respcare.03779. Epub 2015 Mar 10.
The use of endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) has been described in the evaluation of mediastinal lymphadenopathy. Herein, we conduct a meta-analysis to estimate the overall diagnostic yield and safety of EUS-B-FNA combined with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), in the diagnosis of mediastinal lymphadenopathy.
The PubMed and EmBase databases were searched for studies reporting the outcomes of EUS-B-FNA in diagnosis of mediastinal lymphadenopathy. The study quality was assessed using the QualSyst tool. The yield of EBUS-TBNA alone and the combined procedure (EBUS-TBNA and EUS-B-FNA) were analyzed by calculating the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for each study, and pooling the study results using a random effects model. Heterogeneity and publication bias were assessed for individual outcomes. The additional diagnostic gain of EUS-B-FNA over EBUS-TBNA was calculated using proportion meta-analysis.
Our search yielded 10 studies (1,080 subjects with mediastinal lymphadenopathy). The sensitivity of the combined procedure was significantly higher than EBUS-TBNA alone (91% vs 80%, P = .004), in staging of lung cancer (4 studies, 465 subjects). The additional diagnostic gain of EUS-B-FNA over EBUS-TBNA was 7.6% in the diagnosis of mediastinal adenopathy. No serious complication of EUS-B-FNA procedure was reported. Clinical and statistical heterogeneity was present without any evidence of publication bias.
Combining EBUS-TBNA and EUS-B-FNA is an effective and safe method, superior to EBUS-TBNA alone, in the diagnosis of mediastinal lymphadenopathy. Good quality randomized controlled trials are required to confirm the results of this systematic review.
内镜超声联合支气管镜引导下细针穿刺抽吸术（EUS-B-FNA）已被用于纵隔淋巴结肿大的评估。在此，我们进行一项荟萃分析，以评估EUS-B-FNA联合支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）在纵隔淋巴结肿大诊断中的总体诊断率和安全性。
检索PubMed和EmBase数据库，查找报告EUS-B-FNA诊断纵隔淋巴结肿大结果的研究。使用QualSyst工具评估研究质量。通过计算每项研究的敏感性、特异性、阳性似然比、阴性似然比和诊断比值比，分析单独EBUS-TBNA以及联合操作（EBUS-TBNA和EUS-B-FNA）的诊断率，并使用随机效应模型汇总研究结果。评估个体结果的异质性和发表偏倚。使用比例荟萃分析计算EUS-B-FNA相对于EBUS-TBNA的额外诊断增益。
我们的检索产生了10项研究（1080例纵隔淋巴结肿大患者）。在肺癌分期中（4项研究，465例患者），联合操作的敏感性显著高于单独的EBUS-TBNA（91%对80%，P = 0.004）。在纵隔腺病诊断中，EUS-B-FNA相对于EBUS-TBNA的额外诊断增益为7.6%。未报告EUS-B-FNA操作的严重并发症。存在临床和统计异质性，但无发表偏倚的证据。
在纵隔淋巴结肿大的诊断中，将EBUS-TBNA和EUS-B-FNA联合使用是一种有效且安全的方法，优于单独使用EBUS-TBNA。需要高质量的随机对照试验来证实本系统评价的结果。
