Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis.
Introduction. Endobronchial ultrasound (EBUS) is a procedure that provides access to the mediastinal staging; however, EBUS cannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS) is used for complete staging.Objective. To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing mediastinal staging.Methods. Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with surgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses. We produced a meta-analysis including sensitivity, specificity, and likelihood ratio analysis.Results. Twelve primary studies (1515 patients) were included; two were randomized controlled trials (RCTs) and ten were prospective trials. The pooled sensitivity for combined EBUS + EUS was 87% (CI 84-89%) and the specificity was 99% (CI 98-100%). For EBUS + EUS performed with a single bronchoscope group, the sensitivity improved to 88% (CI 83.1-91.4%) and specificity improved to 100% (CI 99-100%).Conclusion. EBUS + EUS is a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy noted at stations that are not traditionally accessible with conventional EBUS.
Facultad de Medicina, Universidad San Sebastián, Lientur 1457, Concepción 4080871, Chile; Division of Internal Medicine, Complejo Asistencial Victor Rios Ruiz, Los Angeles, Chile.
Gonzalo
0000-0002-0069-3420
G
Labarca
Division of Pulmonary Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Carlos
C
Aravena
Division of Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Francisco
F
Ortega
Division of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Alex
A
Arenas
Divisions of Thoracic Surgery and Interventional Pulmonary, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Adnan
A
Majid
Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Erik
E
Folch
Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA.
Hiren J
0000-0001-7331-747X
HJ
Mehta
Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA.
Michael A
MA
Jantz
Unidad de Neumologia Intervencional, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile.
Sebastian
S
Fernandez-Bussy
D001999:Bronchoscopy / Q000379:methods; D019160:Endosonography / Q000379:methods; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008482:Mediastinum / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity