Endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis

Katie Adams ¹, Pallav Shah ², Lyn Edmonds ³ and Eric Lim ^1*

¹ Imperial College and Academic Division of Thoracic Surgery, The Royal Brompton Hospital, United Kingdom
² Department of Respiratory Medicine, The Royal Brompton Hospital, United Kingdom
³ Library and Knowledge Service, Papworth Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: e.lim{at}rbht.nhs.uk.

Accepted 6 May 2009

Abstract

Introduction: Endobronchial ultrasound with transbronchial needle aspiration is becoming widely used for mediastinal lymph node staging in patients with known or suspected lung cancer. Whist 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 endobronchial ultrasound transbronchial needle aspiration as a staging modality.

Objectives: To perform a systematic review of published studies evaluating endobronchial ultrasound transbronchial needle aspiration for mediastinal lymph node staging to ascertain the pooled sensitivity and specificity of this investigation.

Methods: 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.

Measurements and main results: Of 365 publications, we identified 25 where endobronchial ultrasound transbronchial needle aspiration was specifically focused on mediastinal node staging. Of this, 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 – 1.00), similarly this technique has excellent pooled specificity of 1.00 (95% CI 0.92-1.00) and good pooled sensitivity of 0.88 (95% CI 0.79 – 0.94).

Conclusions: Endobronchial ultrasound transbronchial needle aspiration has excellent overall test performance and specificity for mediastinal lymph node staging in patients with lung cancer, with results that compare favourably to published results of CT and PET.