Facultad de Medicina, Universidad San Sebastian, Concepcion, Chile.
Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Ann Am Thorac Soc. 2019 Nov;16(11):1432-1439. doi: 10.1513/AnnalsATS.201902-175OC.
Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive method used to diagnose suspected mediastinal lymph nodes or masses. However, the accuracy of the diagnosis in patients with suspected lymphoma is unclear. To evaluate the diagnostic yield of EBUS-TBNA in patients with suspected lymphoma. A literature search including EMBASE, MEDLINE, Cochrane Library, and Google Scholar was performed by two reviewers. Included articles were evaluated using the QUADAS-2 tool and meta-analysis with a binary method model to compare the sensitivity, specificity, and summary receiver operating characteristic curve in patients with suspected lymphoma. Fourteen studies (425 participants) were pooled in the analysis. EBUS-TBNA reported an overall sensitivity of 66.2% (confidence interval [CI], 55-75.8%; = 76.2%) and specificity of 99.3% (CI, 98.2-99.7%; = 40%). For a new diagnosis of lymphoma, 13 studies including 243 participants reported sensitivity of 67.1% (CI, 54.2-77.9%; = 66.8%) and specificity of 99.6% (CI, 99.1-99.8%; = 0%). For recurrence of lymphoma, 11 studies including 166 participants reported sensitivity of 77.8% (CI, 68.1-85.2%; = 20.2%) and specificity of 99.5% (CI, 98.9-99.8%; = 0%). In the recurrence group, we found the use of rapid onsite examination, sample size, and flow cytometry increased the sensitivity of EBUS-TBNA, albeit a potential source of heterogeneity. EBUS-TBNA has fair sensitivity for identifying a new diagnosis of lymphoma and fair to good sensitivity for identifying recurrence. PROSPERO CRD42018102773 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=102773.
经支气管超声内镜引导下针吸活检术（EBUS-TBNA）是一种微创方法，用于诊断疑似纵隔淋巴结或肿块。然而，在疑似淋巴瘤患者中的诊断准确性尚不清楚。本研究旨在评估 EBUS-TBNA 在疑似淋巴瘤患者中的诊断效能。两位研究者通过 EMBASE、MEDLINE、Cochrane 图书馆和 Google Scholar 进行了文献检索。采用 QUADAS-2 工具评估纳入的文献，并采用二项式方法模型进行荟萃分析，以比较疑似淋巴瘤患者的敏感性、特异性和汇总受试者工作特征曲线。对 14 项研究（425 例患者）进行了汇总分析。EBUS-TBNA 报告的总体敏感性为 66.2%（95%CI，55-75.8%； = 76.2%），特异性为 99.3%（95%CI，98.2-99.7%； = 40%）。对于新诊断的淋巴瘤，13 项研究（包括 243 例患者）报告敏感性为 67.1%（95%CI，54.2-77.9%； = 66.8%），特异性为 99.6%（95%CI，99.1-99.8%； = 0%）。对于淋巴瘤的复发，11 项研究（包括 166 例患者）报告敏感性为 77.8%（95%CI，68.1-85.2%； = 20.2%），特异性为 99.5%（95%CI，98.9-99.8%； = 0%）。在复发组中，我们发现快速现场细胞学检查、样本量和流式细胞术的使用提高了 EBUS-TBNA 的敏感性，但这也是异质性的一个潜在来源。EBUS-TBNA 对诊断新诊断的淋巴瘤具有中等敏感性，对诊断复发具有良好到中等敏感性。PROSPERO CRD42018102773 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=102773.
