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Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration
Published on: November 10, 2014
Diagnostic Performance and Safety of Endobronchial Ultrasound-Guided Sampling for Mediastinal/Hilar Lymphadenopathy:
Shuping Lyu1,2, Ziwen Zheng1,3, Junwei Guo1
1National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, 2nd Yinghuadong Street, Beijing, People's Republic of China.
Introduction:
Mediastinal and/or hilar lymphadenopathy (MHL) has become more frequently identified. Despite advances in endobronchial ultrasound (EBUS)-guided sampling, evidence on the optimal modality is lacking. This systematic review and network meta-analysis aimed to compare the diagnostic performance and safety of different EBUS-guided sampling methods in MHL.
Methods:
This study was performed on published studies reporting the diagnostic performance and complications of EBUS-guided transbronchial needle aspiration (EBUS-TBNA), EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC), EBUS-guided transbronchial forceps biopsy (EBUS-TBFB) to sample MHL. The outcomes included the diagnostic yield, diagnostic sensitivity, negative predictive value and complications. A frequentist random-effects model was employed to rank the diagnostic performance and safety for network meta-analysis. Subgroup analysis was performed with stratification by disease.
Results:
Twenty-two studies with 2357 patients were included. EBUS-TBMC had the highest diagnostic yield, at 88.0%, surpassing EBUS-TBFB (77.1%) and EBUS-TBNA (67.7%). For lymphoma, EBUS-TBMC achieved a diagnostic sensitivity of 94.1%, substantially higher than EBUS-TBNA (40.8%). For benign conditions, EBUS-TBMC (87.9%) also outperformed EBUS-TBNA (55.2%). In the network meta-analysis, the combination of EBUS-TBMC with EBUS-TBNA was the most effective approach and was significantly better than EBUS-TBNA alone. EBUS-TBMC was the best single method for diagnosing sarcoidosis. EBUS sampling can be considered acceptably safe, with the vast majority of complications being grade 1-2 bleeding.
Conclusion:
EBUS-TBNA remains the established standard for diagnosing lung cancer among patients with MHL. EBUS-TBMC demonstrates superior overall performance, particularly in the diagnosis of benign entities and rare carcinomas. EBUS-TBFB plays a supplementary role. All of the techniques exhibit an acceptable safety profile.
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