Combined EBUS-IFB and EBUS-TBNA vs EBUS-TBNA Alone for Intrathoracic Adenopathy: A Meta-Analysis

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 I² 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.