Utility and Safety of Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration in Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis

Abstract

BACKGROUND: The use of endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) has been described in the evaluation of mediastinal lymphadenopathy. Herein, we conduct a meta-analysis to estimate the overall diagnostic yield and safety of EUS-B-FNA combined with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), in the diagnosis of mediastinal lymphadenopathy. METHODS: The PubMed and EmBase databases were searched for studies reporting the outcomes of EUS-B-FNA in diagnosis of mediastinal lymphadenopathy. The study quality was assessed using the QualSyst tool. The yield of EBUS-TBNA alone and the combined procedure (EBUS-TBNA and EUS-B-FNA) were analyzed by calculating the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for each study, and pooling the study results using a random effects model. Heterogeneity and publication bias were assessed for individual outcomes. The additional diagnostic gain of EUS-B-FNA over EBUS-TBNA was calculated using proportion meta-analysis. RESULTS: Our search yielded 10 studies (1,080 subjects with mediastinal lymphadenopathy). The sensitivity of the combined procedure was significantly higher than EBUS-TBNA alone (91% vs 80%, P ‫؍‬ .004), in staging of lung cancer (4 studies, 465 subjects). The additional diagnostic gain of EUS-B-FNA over EBUS-TBNA was 7.6% in the diagnosis of mediastinal adenopathy. No serious complication of EUS-B-FNA procedure was reported. Clinical and statistical heterogeneity was present without any evidence of publication bias. CONCLUSIONS: Combining EBUS-TBNA and EUS-B-FNA is an effective and safe method, superior to EBUS-TBNA alone, in the diagnosis of mediastinal lymphadenopathy. Good quality randomized controlled trials are required to confirm the results of this systematic review.

New technologies in diagnostic bronchoscopy – an age of meta-analyses

“…In combination with esophageal ultrasound-guided fine-needle aspiration (EUS-FNA ), it can provide more extensive mediastinal lymph node evaluation. A meta-analysis which evaluated EUS-B-FNA versus EUS-B-FNA plus EBUS-TBNA confirmed superiority of combination in lung cancer staging [13]. Analysis of 10 trials with 1080 subjects having mediastinal lymphadenomegaly showed sensitivity of the combined procedure significantly higher than EBUS-TBNA alone (91% vs. 80%, p = 0.004).…”

Bronchoscopic Decompression of Mediastinal Lymph Node Abscess Using Endobronchial Ultrasound

“…However, EBUS bronchoscope has been also used to perform transesophageal needle aspiration and the technique is called as Endoscopic ultrasound (with bronchoscope)-guided fine needle aspiration (EUS-B-FNA) in some centres. Where such expertise exists mediastinal masses could potentially be approached in same sitting via both transbronchial and transesophageal routes and this may increase diagnostic yield [18]. Experience with EUS-B-FNA was limited and was not routine practice in our unit.…”

The role of bronchoscopy in the diagnosis of airway disease

“…Endoscopic ultrasound guided FNA (through the esophagus) can increase access to left paratracheal, inferior mediastinum, and aortopulmonary window nodes. When added to EBUS-TBNA, it can increase the ability to diagnose lymphadenopathy by 7.6% (37).…”