Comparison of Endobronchial Ultrasound-Guided Fine Needle Aspiration and Video-Assisted Mediastinoscopy for Mediastinal Staging of Lung Cancer

Abstract

Video-assisted mediastinoscopy (VAM) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are the two most commonly used invasive methods for mediastinal staging of lung cancer. The objective of this review is to assess and compare the overall diagnostic values of VAM and EBUS-TBNA. PubMed, Embase, Web of Science and the Cochrane Library were searched for studies that evaluated EBUS-TBNA or VAM accuracy. Quantitative meta-analysis was used to pool sensitivity and specificity, and study quality was evaluated. Meta-regression was applied to indirectly compare EBUS-TBNA and VAM after adjusting quality score, study design, and station number. A total of ten studies with 999 EBUS-TBNA patients and seven studies with 915 VAM patients were included. Since the pooled specificity was 100% for both modalities, sensitivity was mainly analyzed. The pooled sensitivities for EBUS-TBNA and VAM were 0.84 (95% CI 0.79-0.88) and 0.86 (95% CI 0.82-0.90), respectively. Subgroup analyses of quality score, study design, station number and rapid on-site cytologic evaluation showed no significant influence on the overall sensitivity of the two modalities. After adjusting quality score, study design, and station number, the pooled sensitivities of VAM and EBUS-TBNA were not significantly different. However, more procedural complications and fewer false negatives (FN) were found with VAM than EBUS-TBNA. VAM and EBUS exhibited equally high diagnostic accuracy for mediastinal staging of lung cancer. Due to lower morbidity with EBUS-TBNA and fewer FN with VAM, EBUS-TBNA should be performed first, followed by VAM in the case of a negative needle result.

The role of endobronchial ultrasound versus mediastinoscopy for non-small cell lung cancer

“…EBUS-TBNA performance in mediastinal LN staging in lung cancer has also been compared to that of Med, in prospective studies (19,20,35) (Table 1) and recently in a meta-analysis (56). Populations with moderate and high prevalence of mediastinal nodal metastasis were assessed (prevalence ranged from 32% to 89%).…”

“…However, per LN analysis showed that EBUS-TBNA had higher diagnostic accuracy (91%) than Med (78%, P=0.007). Recently, a large meta-analysis was conducted comparing indirectly diagnostic yield of mediastinal staging with EBUS-TBNA to that of Med (56). Ten EBUS-TBNA and seven Med studies were included.…”

New technologies in diagnostic bronchoscopy – an age of meta-analyses

“…But, these new technologies are very expensive, they require highly trained personnel, and they are usually reserved for centers of excellence. Some of the techniques, especially after the recognition of high diagnostic yield and usefulness, should be made readily available even in less advanced centers [18][19][20].…”

Endobronchial ultrasound-guided transbronchial needle aspiration and cervical mediastinoscopy for mediastinal staging of non-small cell lung cancer: a retrospective comparison study

“…A prospective, crossover trial to compare the diagnostic yield of EBUS-TBNA and CMS was conducted by Ernst in 2008, and the results indicated that the yield of N staging accuracy was not different between two methods, but the sensitivity of EBUS-TBNA in lymph node station diagnosis was higher than that of CMS (25). Several systemic reviews also concluded that the pooled sensitivities of EBUS-TBNA and CMS had no significant differences, and both exhibited equally high diagnostic accuracy for mediastinal staging of lung cancer (20,26).…”