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.