Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis
ABSTRACT Endobronchial ultrasound (EBUS) with transbronchial needle aspiration (TBNA) is becoming widely used for mediastinal lymph node staging in patients with known or suspected lung cancer. While a substantial number of case series have evaluated test performance of this investigation, the small sample sizes limited the ability to accurately evaluate the precision of EBUS-TBNA as a staging modality. A systematic review was performed of published studies evaluating EBUS-TBNA for mediastinal lymph node staging to ascertain the pooled sensitivity and specificity of this investigation.
A literature search was constructed and performed by a professional medical librarian to identify the literature from 1960 to February 2008. Pooled specificity and sensitivity was estimated from the extracted data with an exact binomial rendition of the bivariate mixed-effects regression model.
Of 365 publications, 25 were identified in which EBUS-TBNA was specifically focused on mediastinal node staging. Of these, only 10 had data suitable for extraction and analysis. The overall test performance was excellent with an area under the summary receiver operating characteristics curve of 0.99 (95% CI 0.96 to 1.00); similarly, EBUS-TBNA had excellent pooled specificity of 1.00 (95% CI 0.92 to 1.00) and good pooled sensitivity of 0.88 (95% CI 0.79 to 0.94).
EBUS-TBNA has excellent overall test performance and specificity for mediastinal lymph node staging in patients with lung cancer. The results compare favourably with published results for computed tomography and positron emission tomography.
- SourceAvailable from: Melissa I. Y Wickremasinghe[Show abstract] [Hide abstract]
ABSTRACT: Isolated mediastinal lymphadenopathy can result from a number of potentially serious aetiologies. Traditionally those presenting with mediastinal lymphadenopathy would undergo mediastinoscopy to elucidate a final diagnosis or receive empirical treatment. There is now increased utilization of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), in this setting. Five cases of mediastinal lymphadenopathy are presented here in which lymph node anthracosis was identified as the primary diagnosis using EBUS-TBNA. They were female, non-smokers presenting with non-specific symptoms, who retrospectively reported cooking over wood fires. Four were from South Asia. Three were investigated by F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scanning and increased signal was identified in the anthracotic nodes sampled. With expansion of PET/CT and EBUS-TBNA services it is likely that primary nodal anthracosis will be encountered more frequently and should be considered in the differential diagnosis of those with PET/CT positive lymphadenopathy. It may mimic pathologies including tuberculosis and malignancy, thus accurate sampling and follow-up are essential.12/2013; 10:48–52. DOI:10.1016/j.rmcr.2013.09.005
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ABSTRACT: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established modality for nodal staging in lung cancer; nevertheless, acquisition on effective fiberscope handling and puncture techniques remains challenging. Here, we present a novel EBUS-TBNA learning system protocol and evaluate the ability of physicians trained using this protocol to perform cytological diagnosis and histological sampling. We designed a 5-step learning system as follows: (1) preparation, (2) probe insertion, (3) sonographic observation, (4) TBNA assistant, and (5) TBNA operator. Each trainee must accomplish the first 4 steps before beginning step 5. In step 5, EBUS-TBNA was performed in tandem by the trainee and supervisor. Diagnostic accuracy and success of histological sampling were recorded for each trial; results of the corresponding supervisor served as a control. All 11 trainees entered step 5 after completing steps 1-4 over 5-10 trials. A total of 308 nodes were punctured in step 5. The overall accuracy of cytological diagnosis was 91.2% among trainees, and the histological sampling success rate was 85.4%. The diagnostic accuracy increased from 85.4% to 93.9% (p=0.027) after 12 needle aspiration experiences. The sizes of nodes associated with success and failure were 13.6 and 11.1mm (p=0.001), respectively. Our EBUS-TBNA learning system provided a satisfactory educational pathway for trainees and can be used to improve accessibility of EBUS-TBNA.06/2012; 50(2):46-53. DOI:10.1016/j.resinv.2012.04.002
Article: Endobronchialer Ultraschall[Show abstract] [Hide abstract]
ABSTRACT: Der endobronchiale Ultraschall (EBUS), einer der wichtigsten Fortschritte der vergangenen Jahre in der Pneumologie, ermöglicht die Darstellung der Bronchialwände und parabronchialen Strukturen und hat somit das Spektrum der bronchoskopischen Diagnostik entscheidend erweitert. Es stehen dabei sowohl radiäre Ultraschallsonden als auch Ultraschallbronchoskope, die eine transbronchiale Nadelaspiration (TBNA) unter simultaner sonographischer Visualisierung (EBUS-TBNA) ermöglichen, zur Verfügung. Durch die hohe diagnostische Aussagekraft, den minimalen zusätzlichen Aufwand im Rahmen der Bronchoskopie sowie das geringe Risikoprofil ist der EBUS zur Routineanwendung in pneumologischen Zentren geworden. Vor allem zur Diagnosestellung mediastinaler Raumforderungen als auch zur Komplettierung des Stagings beim Bronchialkarzinom hat sich der EBUS im klinischen Alltag bewährt. Insbesondere trägt die EBUS-TBNA mit einer Sensitivität von 88% und einer Spezifität von 100% zur Evaluation des hilären und mediastinalen Lymphknotenstatus bei Bronchialkarzinomen bei. Daher nimmt der endobronchiale Ultraschall einen bedeutenden Stellenwert in der interdisziplinären Leitlinie zur „Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms“ ein. Endobronchial ultrasound (EBUS), one of the most important advances in pneumology in recent years, provides visualization of bronchial walls and parabronchial structures, extending the diagnostic spectrum of bronchoscopic techniques. Two different techniques are available: radial endobronchial ultrasound and the technique of ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Due to a high diagnostic informative value, low effort and low risk, EBUS has become incorporated into routine practice in pulmonary centers. Thus endobronchial ultrasound has proved to be of increasing importance in the diagnosis of mediastinal mass and staging of lung cancer. EBUS-TBNA is particularly useful for the evaluation of hilar and mediastinal lymph nodes in cases of lung neoplasms with a sensitivity of 88% and specificity of 100%. EBUS therefore plays an important role in the new interdisciplinary guidelines on “prevention, diagnostics, therapy and aftercare of lung cancer”. SchlüsselwörterEndobronchialer Ultraschall (EBUS)-Bronchialkarzinom-Mediastinum-Tumorstaging-Transbronchiale Nadelaspiration (TBNA) KeywordsEndobronchial ultrasound (EBUS)-Lung cancer-Mediastinum-Tumor staging-Transbronchial needle aspiration (TBNA)Der Radiologe 08/2010; 50(8):692-698. DOI:10.1007/s00117-009-1946-4 · 0.41 Impact Factor