Endoscopic ultrasound: It’s accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review

Abstract

AIM:To evaluate the accuracy of endoscopic ultrasound (EUS), EUS-fine needle aspiration (FNA) in evaluating mediastinal lymphadenopathy. METHODS:Only EUS and EUS-FNA studies confirmed by surgery or with appropriate follow-up were selected. Articles were searched in Medline, Pubmed, and Cochrane control trial registry. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Pooling was conducted by both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights.RESULTS: Data was extracted from 76 studies (n = 9310) which met the inclusion criteria. Of these, 44 studies used EUS alone and 32 studies used EUS-FNA. FNA improved the sensitivity of EUS from 84.7% (95% CI: 82.9-86.4) to 88.0% (95% CI: 85.8-90.0). With FNA, the specificity of EUS improved from 84.6% (95% CI:83.2-85.9) to 96.4% (95% CI: 95.3-97.4). The P for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION: EUS is highly sensitive and specific for the evaluation of mediastinal lymphadenopathy and FNA substantially improves this. EUS with FNA should be the diagnostic test of choice for evaluating mediastinal lymphadenopathy.

EBUS-TBNA: Are Two Needle Revolutions (Back and Forth Movement of the Needle Inside the Lymph Node) Adequate for Diagnosis of Lung Cancer?

“…A number of studies examining epithelial malignancies have been conducted that highlight this predicament [6,7]. It has been suggested that the generation of significant false negative results can be explained by detection error.…”

“…A numbers of studies examining epithelial malignancies have been conducted that highlight this predicament [6,7]. Additionally, the advent of targeted therapy and better outcomes in non-small cell lung cancer has made adequacy of tissue for histo-pathological sub-typing followed by mutation identification more important than before.…”

First endoscopic procedure for diagnosis and staging ofmediastinal lymphadenopathy

“…This would mean that EUS-FNA could be selected as the first procedure, rather than routinely subjecting all patients to bronchoscopy. Indeed, a recent meta-analysis has suggested that EUS-FNA is the diagnostic test of choice for mediastinal lymphadenopathy [23] . In addition, the transesophageal route may be better tolerated as compared to the transbronchial route, with less coughing and the absence of obstruction of the needle by cartilaginous rings.…”

Endoscopic Modalities in Diagnosis of Lung Cancer

“…EUS ile metastaz saptanması konusunu (çölyak lenf bezleri, karaciğerin sol lobunda ve sol sürrenal bezde) olgu serileri ve gözlemsel çalışmalar dışında sistematik olarak değerlendiren çalışmalar bulunmamaktadır (29,30,31).…”