Effect of Needle Size on Diagnostic Sensitivity of Endobronchial Ultrasound-Transbronchial Needle Aspiration in Sarcoidosis: A Systematic Review and Meta-Analysis

Abstract

Sarcoidosis is a multisystem disease characterized by non-caseating granulomatous inflammation that most commonly involves the lungs. Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) has become an invaluable tool in the assessment of patients with mediastinal and/or hilar lymphadenopathy. It has been hypothesized that use of the larger 19-gauge (G) needle with EBUS-TBNA improves diagnostic sensitivity in sarcoidosis. However, it is unclear whether the existing literature supports this supposition. METHODS:A literature search of EMBASE, MEDLINE, Cochrane Library, and Google Scholar was performed by two reviewers. Included articles were evaluated for bias using the QUADAS-2 tool. For quantitative analysis, we performed a meta-analysis using a binary random-effects model to determine pooled sensitivity. Subgroup analysis was performed based on needle size, use of ROSE, study design, and prevalence of sarcoidosis in study group. RESULTS:Sixty-five studies with a total of 4242 patients were included in the meta-analysis. Overall pooled sensitivity for diagnosis of sarcoidosis was 83.99% (95% CI 81.22 -86.53) among all studies. The 19G subgroup had a significantly higher sensitivity (93.73%; 95% CI 89.72% -97.74%; I2 0.00%; p<0.01) compared to 21G subgroup (78.52%; 95% CI 66.89% -90.15%; I2 93.05%), 22G subgroup (84.07%; 95% CI 80.90% -87.24%; I2 85.21%) or unspecified 21G/22G subgroup (78.85%; 95% CI 70.81% -86.90%; I2 84.47%). There were no significant differences with use of ROSE, prevalence of sarcoidosis or by study design. CONCLUSIONS:The use of 19G needles during EBUS-TBNA appears to improve diagnostic sensitivity for sarcoidosis compared to 21G and 22G needles.CLINICAL IMPLICATIONS: The use of 19G needles during EBUS-TBNA should be considered in patients with suspected sarcoidosis. Further primary studies in 19G needle use is recommended for any indication.