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Updated: Sep 17, 2025
Author Spotlight: Demonstrating Systematic Endobronchial Ultrasound to New Endoscopists
Published on: August 11, 2023
Artificial intelligence-assisted endobronchial ultrasound for differentiating between benign and malignant thoracic
Fei Tang1, Xian-Kui Zha2, Wei Ye2
1Respiratory and Critical Care Medicine Department and Endoscopic Diagnosis and Treatment Center, Anhui Chest Hospital, Hefei, 230022, Anhui Province, China. tangfei1205@163.com.
Background:
Endobronchial ultrasound (EBUS) is a widely used imaging modality for evaluating thoracic lymph nodes (LNs), particularly in the staging of lung cancer. Artificial intelligence (AI)-assisted EBUS has emerged as a promising tool to enhance diagnostic accuracy. However, its effectiveness in differentiating benign from malignant thoracic LNs remains uncertain. This meta-analysis aimed to evaluate the diagnostic performance of AI-assisted EBUS compared to the pathological reference standards.
Methods:
A systematic search was conducted across PubMed, Embase, and Web of Science for studies assessing AI-assisted EBUS in differentiating benign and malignant thoracic LNs. The reference standard included pathological confirmation via EBUS-guided transbronchial needle aspiration, surgical resection, or other histological/cytological validation methods. Sensitivity, specificity, diagnostic likelihood ratios, and diagnostic odds ratio (OR) were pooled using a random-effects model. The area under the receiver operating characteristic curve (AUROC) was summarized to evaluate diagnostic accuracy. Subgroup analyses were conducted by study design, lymph node location, and AI model type.
Results:
Twelve studies with a total of 6,090 thoracic LNs were included. AI-assisted EBUS showed a pooled sensitivity of 0.75 (95% confidence interval [CI]: 0.60-0.86, I² = 97%) and specificity of 0.88 (95% CI: 0.83-0.92, I² = 96%). The positive and negative likelihood ratios were 6.34 (95% CI: 4.41-9.08) and 0.28 (95% CI: 0.17-0.47), respectively. The pooled diagnostic OR was 22.38 (95% CI: 11.03-45.38), and the AUROC was 0.90 (95% CI: 0.88-0.93). The subgroup analysis showed higher sensitivity but lower specificity in retrospective studies compared to prospective ones (sensitivity: 0.87 vs. 0.42; specificity: 0.80 vs. 0.93; both p < 0.001). No significant differences were found by lymph node location or AI model type.
Conclusion:
AI-assisted EBUS shows promise in differentiating benign from malignant thoracic LNs, particularly those with high specificity. However, substantial heterogeneity and moderate sensitivity highlight the need for cautious interpretation and further validation.
Systematic Review Registration:
PROSPERO CRD42025637964.
