1 Division of Oncology and.
2 Division of Pulmonary Medicine, Department of Medicine, and.
Ann Am Thorac Soc. 2018 Jul;15(7):864-874. doi: 10.1513/AnnalsATS.201711-863OC.
An accurate assessment of the mediastinal lymph node status is essential in the staging and treatment planning of potentially resectable non-small-cell lung cancer.
We performed this meta-analysis to evaluate the role of endobronchial ultrasound-guided transbronchial needle aspiration in detecting occult mediastinal disease in non-small-cell lung cancer with no radiologic mediastinal involvement.
The PubMed, Embase, and Cochrane libraries were searched for studies describing the role of endobronchial ultrasound-guided transbronchial needle aspiration in patients with lung cancer with radiologically negative mediastinum. The individual and pooled sensitivity, prevalence, negative predictive value, and diagnostic odds ratio were calculated using the random effects model. Meta-regression analysis, heterogeneity, and publication bias were also assessed.
A total of 13 studies that met the inclusion criteria were included in the meta-analysis. The pooled effect sizes of the different diagnostic parameters were estimated as follows: prevalence, 12.8% (95% confidence interval, 10.4-15.7%); sensitivity, 49.5% (95% confidence interval, 36.4-62.6%); negative predictive value, 93.0% (95% confidence interval, 90.3-95.0%); and log diagnostic odds ratio, 5.069 (95% confidence interval, 4.212-5.925). Significant heterogeneity was noticeable for the sensitivity, disease prevalence, and negative predictive value, but not observed for log diagnostic odds ratio. Publication bias was detected for sensitivity, negative predictive value, and log diagnostic odds ratio but not for prevalence. Bivariate meta-regression analysis showed no significant association between the pooled calculated parameters and the type of anesthesia, imaging used to define negative mediastinum, rapid on-site test usage, and presence of bias by Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. Interestingly, we observed a greater sensitivity, negative predictive value, and log diagnostic odds ratio for studies published before 2010 and for prospective multicenter studies.
Among patients with non-small-cell lung cancer with a radiologically normal mediastinum, the prevalence of mediastinal disease is 12.8% and the sensitivity of endobronchial ultrasound-guided transbronchial needle aspiration is 49.5%. Despite the low sensitivity, the resulting negative predictive value of 93.0% for endobronchial ultrasound-guided transbronchial needle aspiration suggests that mediastinal metastasis is uncommon in such patients.
准确评估纵隔淋巴结状态对于潜在可切除的非小细胞肺癌的分期和治疗计划至关重要。
我们进行了这项荟萃分析，以评估支气管内超声引导下经支气管针吸活检术在无影像学纵隔累及的非小细胞肺癌中检测隐匿性纵隔疾病的作用。
在 PubMed、Embase 和 Cochrane 图书馆中搜索描述支气管内超声引导下经支气管针吸活检术在影像学阴性的肺癌患者中的作用的研究。使用随机效应模型计算个体和汇总的敏感性、患病率、阴性预测值和诊断比值比。还进行了荟萃回归分析、异质性和发表偏倚评估。
共有 13 项符合纳入标准的研究被纳入荟萃分析。不同诊断参数的汇总效应大小估计如下：患病率为 12.8%（95%置信区间，10.4-15.7%）；敏感性为 49.5%（95%置信区间，36.4-62.6%）；阴性预测值为 93.0%（95%置信区间，90.3-95.0%）；和对数诊断比值比为 5.069（95%置信区间，4.212-5.925）。敏感性、疾病患病率和阴性预测值存在显著异质性，但对数诊断比值比未观察到异质性。敏感性、阴性预测值和对数诊断比值比存在发表偏倚，但患病率未观察到发表偏倚。双变量荟萃回归分析显示，汇总计算参数与麻醉类型、用于定义阴性纵隔的影像学方法、快速现场测试使用以及 QUADAS-2 工具评估的偏倚之间无显著关联。有趣的是，我们观察到 2010 年以前发表的研究和前瞻性多中心研究的敏感性、阴性预测值和对数诊断比值比更高。
在影像学正常的非小细胞肺癌患者中，纵隔疾病的患病率为 12.8%，支气管内超声引导下经支气管针吸活检术的敏感性为 49.5%。尽管敏感性较低，但支气管内超声引导下经支气管针吸活检术的阴性预测值为 93.0%，提示此类患者纵隔转移并不常见。
