Department of Pulmonary and Critical Care Medicine, Medipulse Hospital, Jodhpur, India.
Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India.
Respir Med. 2020 Sep;171:106097. doi: 10.1016/j.rmed.2020.106097. Epub 2020 Aug 1.
EBUS is being widely used today for echolocation of lymph nodes for FNAC. We present a systematic review and meta-analysis to assess the diagnostic accuracy of EBUS characteristics of lymph nodes in diagnosing malignancy.
A systematic search of published literature was undertaken using databases like PubMed, Web of Science, Cochrane, Google Scholar and Researchgate. Those studies reporting any endobronchial ultrasonography features of malignant lymph nodes like size, margins, echogenicity, shape, central hilar structure (CHS), coagulation necrosis sign (CNS) or color power doppler index (CPDI) were included for review. Random effects model was used to calculate pooled sensitivity, specificity, positive and negative likelihood ratios (LR), and diagnostic odds ratio (DOR). The review protocol was registered with the International prospective register of systematic reviews (PROSPERO registration no. CRD42019117716).
992 articles were retrieved of which 542 articles were evaluated in detail and finally 29 articles met the inclusion criteria. All EBUS features except CPDI showed a statistically significant area under the SROC curve. CNS showed highest area under the SROC curve [0.81 (SE: 0.09)] with maximum pooled specificity [0.93, 95%CI: 0.92-0.94], maximum pooled LR+ [5.12, 95%CI: 2.56-10.2] and DOR [9.23, 95%CI 3.85-22.15]. Maximum sensitivity was seen for CHS 0.91 [95%CI: 0.90-0.92].
EBUS features have the potential to help in more precise location of a malignant lymph node thereby helping in increasing the diagnostic yield. However, high diagnostic accuracy of various EBUS features can currently only be said to supplement tissue diagnosis.
EBUS 目前广泛用于超声支气管镜引导下经支气管针吸活检术（EBUS-TBNA）对淋巴结进行超声定位。我们进行了系统评价和荟萃分析，以评估 EBUS 对淋巴结恶性肿瘤的特征对诊断准确性。
通过检索 PubMed、Web of Science、Cochrane、Google Scholar 和 Researchgate 等数据库，进行了文献的系统搜索。纳入报告任何经支气管超声特征的研究，如淋巴结大小、边缘、回声、形状、中央门结构（CHS）、凝固性坏死征象（CNS）或彩色多普勒能量指数（CPDI）等。使用随机效应模型计算汇总敏感性、特异性、阳性和阴性似然比（LR）以及诊断优势比（DOR）。该综述方案已在国际前瞻性系统评价注册库（PROSPERO 注册号：CRD42019117716）中进行了注册。
共检索到 992 篇文章，其中 542 篇文章进行了详细评估，最终 29 篇文章符合纳入标准。除 CPDI 外，所有 EBUS 特征均显示出统计显著的 SROC 曲线下面积。CNS 显示出最高的 SROC 曲线下面积[0.81（SE：0.09）]，最大汇总特异性[0.93，95%CI：0.92-0.94]，最大汇总 LR+[5.12，95%CI：2.56-10.2]和 DOR[9.23，95%CI 3.85-22.15]。CHS 的最大敏感性为 0.91[95%CI：0.90-0.92]。
EBUS 特征有可能帮助更精确地定位恶性淋巴结，从而提高诊断率。然而，目前只能说各种 EBUS 特征的高诊断准确性有助于补充组织诊断。
