Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis

Abstract

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.

Oncologic Quality Indicators in Thoracic Surgery

“…High negative predictive values often necessitate confirmatory testing 4, 6, 8 . Emerging data support the complementary roles of EUS-NA, EBUS-NA, and mediastinoscopy to avoid futile surgery 4, 8, 14 . In conclusion, there is high level evidence to support PET-CT, endosonography, and the combination of histological and cytological pathology for quality oncologic staging of the mediastinum 4, 6 .…”

Ultrasonography of the Mediastinum: Techniques, Current Practice, and Future Directions

“…57 Another meta-analysis examined 12 studies (1,515 subjects) to provide a synthesis of the evidence on the diagnostic performance of EBUS plus endoscopic ultrasound in patients who underwent mediastinal staging. 58 The pooled sensitivity for combined EBUS-endoscopic ultra- sound was 87%, and the specificity was 99%, and, for EBUS and endoscopic ultrasound performed with a single bronchoscope group, the sensitivity improved to 88% and specificity improved to 100%. 58 The investigators concluded that EBUS plus endoscopic ultrasound is a highly accurate and safe procedure that should be considered in selected patients with lymphadenopathy that is not accessible with conventional EBUS (Fig.…”

“…2). 58 The sensitivity of endoscopic ultrasound-fine needle aspiration and EBUS-TBNA for the detection of metastatic invasion in subjects selected on the basis of CT enlargement or PET positivity (inclusion criteria shared by the above-mentioned studies) was significantly higher than in subjects with negative CT findings or without any selection based on CT or PET. 42,44 The combined use of endoscopic ultrasound and EBUS prevents Ͼ50% of scheduled surgical staging procedures by diagnosing advanced disease in patients with suspected lung cancer and enlarged or PET-positive lymph nodes.…”

Concordancia diagnóstica entre la broncoscopia y la histopatología en pacientes con neoplasias pulmonares

“…La fibrobroncoscopia flexible es un estudio invasivo que permite la visualización de la vía aérea y la toma de muestras de tejido por medio de lavado broncoalveolar, cepillado bronquial o biopsia transbronquial. 5,[7][8][9][10][11][12] En la actualidad se están desarrollando métodos innovadores fibrobroncoscópicos para la detección temprana de cáncer de pulmón.…”