PURPOSE: To perform a systematic review and meta-analysis of prospectively conducted studies to define diagnostic performance of Endobronchial Ultrasound guided -Transbronchial Needle Aspiration (EBUS-TBNA) in mediastinal and hilar lymphadenopathy.
METHODS: A comprehensive search performed using EMBASE, Ovid MEDLINE(R), Ovid MEDLINE(R) InProcess & Other Non-Indexed Citations, All EBM Reviews - Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CCTR), Health Technology Assessment (HTA), and SCOPUS databases in second week of November 2010. Studies were selected in two phases by two reviewers, independently. Data extraction from each study was performed using a standardized data extraction form. Quality assessment of study methodology was done using a checklist which was developed based on Quality Assessment of Diagnostic Accuracy Studies tool and nature of the test. Using the 2 x 2 tables, we computed sensitivity, specificity and the likelihood ratios.
RESULTS: Fourteen studies included for quantitative data synthesis had pooled cohort of 1658 patients from 8 different countries. The EBUS-TBNA had excellent pooled specificity of 100% (95% CI, 0.90-1.00) and positive likelihood ratio of 5.1 (95% CI, 2.67 - 9.7). The pooled sensitivity was 92% (95%CI, 91- 93) and pooled negative likelihood ratio was 0.13 (95% CI, 0.09 - 0.19). The sensitivity of this intervention was not dependent on rapid on-site evaluation use or size of needle used. Pooled diagnostic odd ratio was 62.7 (95% CI, 25.7 - 153.0). Only one major complication was reported which resulted in early termination of procedure.
CONCLUSIONS: Evidence of moderate quality confirms the higher diagnostic performance of EBUS-TBNA for mediastinal and hilar lymphadenopathy, both in malignant and non-malignant conditions. Available evidence also demonstrates safe nature of this procedure
CLINICAL IMPLICATIONS: Higher sensitivity and specificity with extreme safe nature of the intervention makes EBUS-TBNA an excellent diagnostic test for mediastinal and hilar lymphadenopathy.
DISCLOSURE: The following authors have nothing to disclose: Mahendra Nehra, Subhash Chandra, Dipti Agarwal, Anant Mohan
No Product/Research Disclosure Information