Yang Wuchen, Yang Huizhen, Zhang Quncheng, Herth Felix J F, Zhang Xiaoju
Department of Anesthesiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China.
Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Respiration. 2024;103(12):752-764. doi: 10.1159/000540859. Epub 2024 Aug 13.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be limited by the inadequacy of intact tissues, especially in patients with lymphoma, sarcoidosis, and lymph node tuberculosis. A novel technique called transbronchial node biopsy (TBNB) by forceps or cryoprobe has been proposed and studied to improve specimen quality and diagnostic yield. We performed a systematic review of studies describing the safety and sensitivity of EBUS-TBNB versus EBUS-TBNA in diagnosing intrathoracic lymphadenopathy/masses.
We systematically searched MEDLINE, Embase, Cochrane, and China National Knowledge Infrastructure to identify studies focusing on the application of EBUS-TBNB for diagnosis of intrathoracic lymphadenopathy. The quality of each study was evaluated using the QUADAS-2 tool. Using inverse-variance (I-V) weighting, we performed a meta-analysis of diagnostic yield estimations. We also reviewed the complications related to the procedure.
Thirteen studies were included in the final analysis. The meta-analysis yielded a pooled overall diagnostic yield of 77.80% (939/1,207) for EBUS-TBNA and 86.01% (834/958) for EBUS-TBNB, with an inverse-variance-weighted odds ratio of 3.13 (95% confidence interval [CI], 1.61-6.01; p = 0.0008) and I2 of 82%. The pooled diagnostic yield of EBUS-TBNB versus EBUS-TBNA for the diagnosis of malignancy (including primary lung cancer and extrapulmonary malignancy) was 84.53% (590/698) for EBUS-TBNA and 90.84% (476/524) for EBUS-TBNB, with an I-V-weighted OR of 2.33 (95% CI, 1.15-4.74; p = 0.02) and I2 of 64%. The pooled diagnostic yield of EBUS-TBNB versus EBUS-TBNA for the diagnosis of benignancy was 71.19% (252/354) for EBUS-TBNA and 86.62% (233/269) for EBUS-TBNB, with an I-V-weighted OR of 4.39 (95% CI, 2.00-9.65; p = 0.002) and I2 of 59%. The overall complications included bleeding (n = 11, 0.90%), pneumomediastinum (n = 6, 0.49%), pneumothorax (n = 6, 0.49%), pneumonia (n = 4, 0.33%), respiratory failure (n = 1, 0.08%), and haemoptysis (n = 1, 0.08%). The funnel plot analysis illustrated no major publication bias.
EBUS-TBNB improves the overall diagnostic yield of sampling intrathoracic lymphadenopathy and mass lesions relative to EBUS-TBNA. The complication rate of EBUS-TBNB is higher than that of EBUS-TBNA but reportedly lower than that of surgical biopsies.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）可能会受到完整组织不足的限制，尤其是在淋巴瘤、结节病和淋巴结结核患者中。一种名为经支气管钳取或冷冻探头淋巴结活检术（TBNB）的新技术已被提出并进行研究，以提高标本质量和诊断率。我们对描述EBUS-TBNB与EBUS-TBNA在诊断胸内淋巴结病/肿块方面的安全性和敏感性的研究进行了系统评价。
我们系统检索了MEDLINE、Embase、Cochrane和中国知网，以确定关注EBUS-TBNB在诊断胸内淋巴结病中的应用的研究。使用QUADAS-2工具评估每项研究的质量。采用逆方差（I-V）加权法，我们对诊断率估计值进行了荟萃分析。我们还回顾了与该操作相关的并发症。
最终分析纳入了13项研究。荟萃分析得出，EBUS-TBNA的总体诊断率合并值为77.80%（939/1207），EBUS-TBNB为86.01%（834/958），逆方差加权比值比为3.13（95%置信区间[CI]，1.61-6.01；p = 0.0008），I²为82%。EBUS-TBNB与EBUS-TBNA在诊断恶性肿瘤（包括原发性肺癌和肺外恶性肿瘤）方面的合并诊断率，EBUS-TBNA为84.53%（590/698），EBUS-TBNB为90.84%（476/524），I-V加权OR为2.33（95%CI，1.15-4.74；p = 0.02），I²为64%。EBUS-TBNB与EBUS-TBNA在诊断良性疾病方面的合并诊断率，EBUS-TBNA为71.19%（252/354），EBUS-TBNB为86.62%（233/269），I-V加权OR为4.39（95%CI，2.00-9.65；p = 0.002），I²为59%。总体并发症包括出血（n = 11，0.90%）、纵隔气肿（n = 6，0.49%）、气胸（n = 6，0.49%）、肺炎（n = 4，0.33%）、呼吸衰竭（n = 1，0.08%）和咯血（n = 1，0.08%）。漏斗图分析显示无重大发表偏倚。
相对于EBUS-TBNA，EBUS-TBNB提高了胸内淋巴结病和肿块病变采样的总体诊断率。EBUS-TBNB的并发症发生率高于EBUS-TBNA，但据报道低于手术活检。
