Interventional Pulmonology, Division of Pulmonary, Critical Care, and Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
Interventional Pulmonology, Section of Pulmonary & Critical Care Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
Ann Thorac Surg. 2022 Jul;114(1):340-348. doi: 10.1016/j.athoracsur.2020.12.049. Epub 2021 Jan 21.
Endobronchial ultrasound (EBUS)-guided intranodal forceps biopsy (IFB) is considered complementary to EBUS-guided transbronchial needle aspiration (TBNA) (EBUS-TBNA) for patients with intrathoracic lymphadenopathy either when additional tissue is requested for comprehensive molecular testing or for suspected lymphoma and sarcoidosis. This systematic review and meta-analysis investigated the diagnostic yield and complications of combined EBUS-IFB and EBUS-TBNA compared with EBUS-TBNA alone.
A systematic search was performed of Medline, Embase, and Google Scholar for studies evaluating the use of EBUS-IFB for diagnosis of intrathoracic adenopathy, and the quality of each study was assessed using the Quality Assessment, Data abstraction and Synthesis-2 tool. Using inverse variance weighting, a meta-analysis of diagnostic yield estimations was performed. The complications related to the procedure were also reviewed.
Six observational studies with 443 patients undergoing 467 biopsies were included in the final analysis. Meta-analysis yielded a pooled overall diagnostic yield of 67% (312 of 467) for EBUS-TBNA and 92% (428 of 467) for EBUS-TBNA in combination with EBUS-IFB, with an inverse variance-weighted odds ratio of 5.87 (95% confidence interval, 3081 to 9.04; P < .00001) and an I of 15%. The overall complications included pneumomediastinum (1%), bleeding (0.8%), and respiratory failure (0.6%). The funnel plot analysis illustrated no major publication bias. Subgroup analysis showed increased diagnostic yield for lymphoma (86% vs 30%; P = .03) and sarcoidosis (93% vs 58%; P < .00001).
The addition of EBUS-IFB to EBUS-TBNA improves the overall diagnostic yield of sampling intrathoracic adenopathy when compared with EBUS-TBNA alone. The complication rates of the combined approach are higher than with EBUS-TBNA, but they are reportedly lower than with transbronchial or surgical biopsies.
经支气管超声（EBUS）引导下的腔内活检（IFB）被认为是对胸内淋巴结病患者进行 EBUS 引导下经支气管针吸活检（EBUS-TBNA）的补充，当需要进行全面的分子检测时，或者当怀疑为淋巴瘤和结节病时，会进行额外的组织取样。本系统评价和荟萃分析调查了与单独进行 EBUS-TBNA 相比，联合使用 EBUS-IFB 和 EBUS-TBNA 的诊断率和并发症。
对 Medline、Embase 和 Google Scholar 进行了系统搜索，以评估评估 EBUS-IFB 用于诊断胸内腺病的研究，并使用质量评估、数据提取和合成-2 工具评估每个研究的质量。使用逆方差加权法，对诊断率估计值进行荟萃分析。还回顾了与该程序相关的并发症。
最终分析纳入了 6 项观察性研究，共 443 例患者接受了 467 次活检。荟萃分析显示，EBUS-TBNA 的总体诊断率为 67%（467 例中有 312 例），而 EBUS-TBNA 联合 EBUS-IFB 的总体诊断率为 92%（467 例中有 428 例），逆方差加权比值比为 5.87（95%置信区间，3081 至 9.04；P <.00001），I²为 15%。总体并发症包括纵隔气肿（1%）、出血（0.8%）和呼吸衰竭（0.6%）。漏斗图分析表明没有明显的发表偏倚。亚组分析显示，淋巴瘤（86%比 30%；P =.03）和结节病（93%比 58%；P <.00001）的诊断率增加。
与单独进行 EBUS-TBNA 相比，在 EBUS-TBNA 中加入 EBUS-IFB 可提高对胸内腺病的总体诊断率。联合方法的并发症发生率高于 EBUS-TBNA，但据报道低于经支气管或手术活检。
