Lung · 2026
Diagnostic Performance and Safety of Endobronchial Ultrasound-Guided Sampling for Mediastinal/Hilar Lymphadenopathy: A Systematic Review and Network Meta-analysis.
СтатьяСистематический обзорNetwork Meta-AnalysisНазвание и аннотация: Перевод в очереди
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Lyu Shuping, Zheng Ziwen, Guo Junwei, Yu Xiaoya, Feng Xiaoguo, Deng Mingming, Poletti Venerino, Hou Gang
Аннотация
INTRODUCTION: Mediastinal and/or hilar lymphadenopathy (MHL) has become more frequently identified. Despite advances in endobronchial ultrasound (EBUS)-guided sampling, evidence on the optimal modality is lacking. This systematic review and network meta-analysis aimed to compare the diagnostic performance and safety of different EBUS-guided sampling methods in MHL.
METHODS: This study was performed on published studies reporting the diagnostic performance and complications of EBUS-guided transbronchial needle aspiration (EBUS-TBNA), EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC), EBUS-guided transbronchial forceps biopsy (EBUS-TBFB) to sample MHL. The outcomes included the diagnostic yield, diagnostic sensitivity, negative predictive value and complications. A frequentist random-effects model was employed to rank the diagnostic performance and safety for network meta-analysis. Subgroup analysis was performed with stratification by disease.
RESULTS: Twenty-two studies with 2357 patients were included. EBUS-TBMC had the highest diagnostic yield, at 88.0%, surpassing EBUS-TBFB (77.1%) and EBUS-TBNA (67.7%). For lymphoma, EBUS-TBMC achieved a diagnostic sensitivity of 94.1%, substantially higher than EBUS-TBNA (40.8%). For benign conditions, EBUS-TBMC (87.9%) also outperformed EBUS-TBNA (55.2%). In the network meta-analysis, the combination of EBUS-TBMC with EBUS-TBNA was the most effective approach and was significantly better than EBUS-TBNA alone. EBUS-TBMC was the best single method for diagnosing sarcoidosis. EBUS sampling can be considered acceptably safe, with the vast majority of complications being grade 1-2 bleeding.
CONCLUSION: EBUS-TBNA remains the established standard for diagnosing lung cancer among patients with MHL. EBUS-TBMC demonstrates superior overall performance, particularly in the diagnosis of benign entities and rare carcinomas. EBUS-TBFB plays a supplementary role. All of the techniques exhibit an acceptable safety profile.
METHODS: This study was performed on published studies reporting the diagnostic performance and complications of EBUS-guided transbronchial needle aspiration (EBUS-TBNA), EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC), EBUS-guided transbronchial forceps biopsy (EBUS-TBFB) to sample MHL. The outcomes included the diagnostic yield, diagnostic sensitivity, negative predictive value and complications. A frequentist random-effects model was employed to rank the diagnostic performance and safety for network meta-analysis. Subgroup analysis was performed with stratification by disease.
RESULTS: Twenty-two studies with 2357 patients were included. EBUS-TBMC had the highest diagnostic yield, at 88.0%, surpassing EBUS-TBFB (77.1%) and EBUS-TBNA (67.7%). For lymphoma, EBUS-TBMC achieved a diagnostic sensitivity of 94.1%, substantially higher than EBUS-TBNA (40.8%). For benign conditions, EBUS-TBMC (87.9%) also outperformed EBUS-TBNA (55.2%). In the network meta-analysis, the combination of EBUS-TBMC with EBUS-TBNA was the most effective approach and was significantly better than EBUS-TBNA alone. EBUS-TBMC was the best single method for diagnosing sarcoidosis. EBUS sampling can be considered acceptably safe, with the vast majority of complications being grade 1-2 bleeding.
CONCLUSION: EBUS-TBNA remains the established standard for diagnosing lung cancer among patients with MHL. EBUS-TBMC demonstrates superior overall performance, particularly in the diagnosis of benign entities and rare carcinomas. EBUS-TBFB plays a supplementary role. All of the techniques exhibit an acceptable safety profile.