Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis
- 1Imperial College and Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, UK
- 2Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
- 3Library and Knowledge Service, Papworth Hospital, Cambridge, UK
- Correspondence to Mr E Lim, Imperial College and Academic Division of Thoracic Surgery, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK;
- Received 17 October 2008
- Accepted 6 May 2009
- Published Online First 18 May 2009
Background: 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.
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.
Results: 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).
Conclusions: 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.
▸ Appendices A and B are published online only at http://thorax.bmj.com/content/vol64/issue9
Competing interests None.
Provenance and Peer review Not commissioned; externally peer reviewed.