Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal lymph node staging of lung cancer: a meta-analysis.

STUDY OBJECTIVES

This systematic review and meta-analysis was conducted to evaluate the accuracy of the combined endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) techniques and clarify its current role for the mediastinal lymph node staging of lung cancer.

METHODS

Medline, Web of Science, Elsevier and Ovid were searched to identify suitable studies up to 15th July 2012. Two investigators independently reviewed articles and extracted data. All EBUS-TBNA plus EUS-FNA studies for the mediastinal node staging of lung cancer were systematically reviewed. Sensitivity, specificity and other accuracy measures were pooled using random-effect models. Summary receiver operating characteristic curves were used to summarise overall test performance.

RESULTS

Eight studies met our inclusion criteria. The estimated summary measures for quantitative analysis of EBUS-TBNA plus EUS-FNA for mediastinal nodal staging of lung cancer were sensitivity, 0.86 (95% confidence interval [CI], 0.82-0.90); specificity, 1.00 (95% CI, 0.99-1.00); positive likelihood ratio, 51.77 (95% CI, 22.53-118.94); negative likelihood ratio, 0.15 (95% CI, 0.09-0.25); diagnostic odds ratio, 416.83 (95% CI, 140.08-1240.31); and area under the curve (AUC), 0.99.

CONCLUSIONS

The current evidence suggests that the combined technique is more sensitive than EBUS-TBNA or EUS-FNA alone. The diagnostic power of this combined technique is accurate. As an almost completely minimally-invasive examination, EUS-FNA plus EBUS-TBNA may replace more invasive methods for evaluating mediastinal node staging of lung cancer.