Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis

Abstract

Improved diagnostic sensitivity of bronchsocopy for the investigation of peripheral pulmonary lesions (PPLs) with the use of radial probe endobroncial ultrasound (EBUS) has been reported, although diagnostic performance varies considerably.A systematic review of published literature evaluating radial probe EBUS accuracy was performed to determine point sensitivity and specificity, and to construct a summary receiveroperating characteristic curve. Sub-group analysis and linear regression was used to identify possible sources of study heterogeneity.16 studies with 1,420 patients fulfilled inclusion criteria. Significant inter-study variation in EBUS method was noted. EBUS had point specificity of 1.00 (95% CI 0.99-1.00) and point sensitivity of 0.73 (95% CI 0.70-0.76) for the detection of lung cancer, with a positive likelihood ratio of 26.84 (12.60-57.20) and a negative likelihood ratio of 0.28 (0.23-0.36). Significant interstudy heterogeneity for sensitivity was observed, with prevalence of malignancy, lesion size and reference standard used being possible sources.EBUS is a safe and relatively accurate tool in the investigation of PPLs. Diagnostic sensitivity of EBUS may be influenced by the prevalence of malignancy in the patient cohort being examined and lesion size. Further methodologically rigorous studies on well-defined patient populations are required to evaluate the generalisability of our results.

Radial probe EBUSversusCT-guided needle biopsy for evaluation of peripheral pulmonary lesions: an economic analysis

“…Sensitivity and specificity of EBUS-TBLB for evaluation of PPL was based on our own experience and a published meta-analysis [10,17], while data for CT-PNB was based on our reported experience and published guidelines [2,10]. …”

“…We recognised that model input values may vary significantly across different institutions. For example, diagnostic sensitivity of EBUS-TBLB differs considerably between institutions [17], and there is significant discrepancy in reported complication rates following CT-PNB [2]. Therefore, a series of one-way sensitivity analyses were undertaken within the range of each parameter recorded in table 3, based on data from recent pooled analyses.…”

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

“…It comprises combined use of large channel bronchoscope, ultrasound probe, and driving unit all connected to the ultrasonographic center. One of the latest meta-analyses of rEBUS included 16 trials with 1420 patients [11]. rEBUS had point specificity 100% and point sensitivity 73% for the detection of lung cancer.…”

Current advances of endobronchial ultrasonography in the diagnosis and staging of lung cancer

“…EBUS RP offers guidance during bronchoscopy to help reach the lesion. The diagnostic yield varied from 46% to 86.2% and pooled sensitivity was 73% for all lesions and even better in the diagnosis of lung cancer (15,16). There is no direct comparison between EBUS RB and fluoroscopy in lung cancer diagnosis (17), but combined these two modality increased the diagnostic yield (18).…”

“…The most frequent complications of EBUS RP guidance biopsy are bleeding and pneumothorax. But these complications are self-limited and seldom required intervention (15,35).…”