title: Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Recently, less invasive methods have emerged as potential alternatives for staging with tissue confirmation of suspected metastatic mediastinal lymph nodes in lung cancer. The objective of this review was to assess the overall diagnostic accuracy of EBUS-TBNA in detecting metastatic mediastinal lymph node in lung cancer with a meta-analysis.
  
  
  METHODS
  The MEDLINE, EMBASE, Cancerlit and Cochrane Library database, from January 1995 to September 2008, were searched for studies evaluating EBUS-TBNA accuracy. Meta-analysis methods were used to pool sensitivity and specificity and to construct summary receiver-operating characteristic.
  
  
  RESULTS
  A total of 11 studies with 1299 patients, who fulfilled all of the inclusion criteria, were considered for the analysis. No publication bias was found. EBUS-TBNA had a pooled sensitivity of 0.93 (95% CI, 0.91-0.94) and a pooled specificity of 1.00 (95% CI, 0.99-1.00). The subgroup of patients who were selected on the basis of CT or PET positive results had higher pooled sensitivity (0.94, 95% CI 0.93-0.96) than the subgroup of patients without any selection of CT or PET (0.76, 95% CI 0.65-0.85) (p<0.05). Study sensitivity was not correlated with the prevalence of lymph node metastasis. Only two complications occurred (0.15%).
  
  
  CONCLUSIONS
  EBUS-TBNA was an accurate, safe and cost-effective tool in lung cancer staging. The selection of patients who had positive results of suspected lymph node metastasis in CT or PET may improve the sensitivity of EBUS-TBNA. High-quality prospective studies regarding EBUS-TBNA in lung cancer staging are still needed to be conducted.
authors.affiliation: Respiratory Department, Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine, No. 214, West Huaihai Road, Shanghai 200030, PR China.
authors.forename: Ping
authors.initials: P
authors.lastname: Gu
authors.forename: Yi-Zhuo
authors.initials: YZ
authors.lastname: Zhao
authors.forename: Li-Yan
authors.initials: LY
authors.lastname: Jiang
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: Yu
authors.initials: Y
authors.lastname: Xin
authors.forename: Bao-Hui
authors.initials: BH
authors.lastname: Han
mesh_terms: D019540:Area Under Curve; D001707:Biopsy, Needle / Q000379:methods; D019160:Endosonography / Q000379:methods; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000379:methods