Tables
- Table 1—
Results of studies that assess the effectiveness and safety of endobronchial ultrasound(EBUS)-guided transbronchial needle aspiration (TBNA) in bronchopulmonary cancer
First author [ref] Type of study Patients/procedures included Reference/comparison test Diagnostic performance P Adequate sample Safety S Sp PPV NPV Lee 18# Prospective 91 patients with strongly suspected or histologically confirmed potential NSCLC with lymph nodes accessible to EBUS–TBNA (5–20 mm on CT). Exclusion of M1 disease, inoperable T4 disease, N3 disease with spread to supra-clavicular lymph node, lymph nodes >2 cm or extranodal invasion. Cytology results in positive cases Surgery (open thoracotomy or video-assisted thoracic surgery) in patients without mediastinal metastasis. No mediastinoscopy performed 93.8% 100% 100% 96.9% 42% 92% Wallace 19¶ Prospective 138 consecutive patients with known or suspected lung cancer on the basis of CT abnormality but no proven extrathoracic metastases Blinded comparison Pathological confirmation for positive results Surgical sampling by mediastinoscopy or thoracoscopy, open surgical exploration or 6–12 months of follow-up PET 28% 100% No complications 24% 90% CT 67% 53% TBNA 36% 100% 100% 78% EUS–FNA 69% 100% 100% 88% EBUS–TBNA 69% 100% 100% 88% EUS–FNA + EBUS–TBNA 93% 100% 100% 97% Bauwens 20# Prospective collection and retrospective assessment 106 patients with proven lung cancer (staging) or suspected lung cancer on FDG–PET (33 combined PET/CT) Cytology/histology results in positive cases Surgical staging (30 out of 46), diagnostic procedures or follow-up in negative cases Blind retrospective comparison EBUS–TBNA (n = 90 patients) 58% 94% Side-effects, notably cough, seldom encountered 93% 100% 100% 91% FDG–PET (n = 41 patients) 67% 100% Vincent 21# Retrospective 152 procedures carried out in 152 patients with primary lung masses or/and mediastinal adenopathy Cytology results in positive cases with or without surgical confirmation Mediastinoscopy, lung resection, CT, FDG–PET or metabolic activity 99.1% 100% 100% 97% 74.3% 95.4% No complications Herth 17# Prospective 97 patients highly suspicious for NSCLC with CT scans showing lymph nodes <1 cm and negative PET in mediastinum Surgical results in all patients 89% 100% 100% 98.9% 9.2% Monsó 22# Prospective 67 patients with pulmonary neoplasms and mediastinal and/or lobular lymph nodes >5 mm on ultrasound Cytology Diagnostic yield 92.5% 55.2% 87.8% No complications Nakajima 14# Retrospective 43 patients with suspected metastasis of lung cancer and lymph nodes ≥5 mm on CT Cytology or histology results in positive cases Thoracotomy, thoracoscopy or clinical follow-up (≥6 months) 92% 100% 100% 90% 53.5% 95.3% No complications Herth 15# Prospective 502 patients with mediastinal or hilar adenopathies (>1 cm; unknown origin or staging of lung cancer, especially exclusion of N3 nodes) Cytology in positive cases Surgery or clinical follow-up in negative cases 94% 100% 11% 98.2% 93.5% No complications Herth 16# Prospective 100 patients with suspected tumour of pulmonary origin evidenced by CT (T1–T4), without enlargement of lymph nodes (measuring <1 cm) or diagnosis of suspected or known NSCLC Mediastinoscopy (15%) or thoracotomy (85%) with resection of mediastinal nodes in all patients 92.3% 100% 96.3% 17% 100% No complications Yasufuku 13# Prospective 102 patients with suspected or anatomopathologically-confirmed lung cancer who were considered candidates for curative thoracic surgery (patients with stage I, II, or clinical minimal IIIa disease). Extensive N2/N3 disease excluded Thoracotomy performed or diagnosis made from dissection of lymph nodes in potentially operable patients, and follow-up conducted in other patients (N3 or extensive N2 disease). EBUS–TBNA 100% 100% No major complications 92.3% 100% 100% 97.4% CT 76.9% 55.3% 37% 87.5% FDG–PET 80% 70.1% 46.5% 91.5% Yasufuku 12# Prospective 108 patients with suspected NSCLC or proven lung cancer and enlarged mediastinal lymph nodes (>1 cm) or mediastinal lesions suspected of malignancy detected by CT (N2 or N3) Positive cytologies regarded as final diagnosis Follow-up of the disease and confirmation by thoracic lymphadenopathy in negative cases 94.6% 100% 100% 89.5% 62.9% 97.2% No complications Rintoul 23# Prospective 18 patients with suspected or known lung cancer and detection of nodular enlargement or presence of paratracheal or parabronchial masses on CT Positive cytologies regarded as final diagnosis Benign results confirmed by surgery (n = 4) or clinical follow-up (n = 1) 85% 100% 100% 71.4% 72.2% 100% No complications Vilmann 24# Prospective 33 patients for staging of lung cancer (n = 20) or diagnosis of mediastinal lesions (n = 13) Thoracotomy (n = 9), clinical follow-up (n = 19) EBUS–TBNA 93.9% 95% No complications 85% 100% 72% EUS–FNA 80% 100% 66% Yasufuku 9# Prospective 70 patients with hilar and/or mediastinal lymphadenopathies (>1 cm) and with suspected or confirmed lung cancer. Positive cytologies regarded as final diagnosis In benign results confirmation by thoracotomy or surgery (n = 21) and by clinical follow-up (n = 3) 95.7% 100% 68.5% 96% No complications S: sensitivity; Sp: specificity; PPV: positive predictive value; NPV: negative predictive value; P: prevalence of lymph node malignancy; NSCLC: nonsmall cell lung cancer; CT: computerised tomography; M: metastasis; T: tumour; N: lymph node; PET: positron emission tomography; EUS: transoesophageal ultrasonography; FNA: fine-needle aspiration; FDG: fluorodeoxyglucose. #: patient-based analysis; ¶: lesion-based analysis.
- Table 2—
Results of studies that assess the effectiveness and safety of endobronchial ultrasound(EBUS)-guided transbronchial needle aspiration (TBNA) in sarcoidosis and lymphoma
Author and year Type of study Patients included Reference/comparison test Diagnostic performance P Adequate sample Safety S Sp PPV NPV Diagnosis of sarcoidosis Wong 27 Prospective 65 patients with clinical and radiological findings suggestive of sarcoidosis and enlargement of lymph and/or mediastinal nodes (>1 cm) Positive cytologies taken as final diagnosis In benign results, mediastinoscopy (n = 5), thoracoscopy (n = 1) and clinical follow-up (n = 3) 91.8% 87.5%# 11%# 100% 95.3% No important complications Oki 28 Prospective 15 patients with clinical and radiological findings suggestive of sarcoidosis and enlargement of lymph and/or mediastinal nodes (>1 cm) TBNA in all patients Diagnostic performance of EBUS–TBNA 93% 93.3% No complications Diagnostic performance of TBNA 94% Garwood 29 Prospective 50 patients with suspicion of sarcoidosis (90% with clinical symptoms and adenopathy on radiographic imaging) Positive cytologies taken as final diagnosis In benign results, histology samples (obtained by EBUS–TBNA or transbronchial lung biopsy, endobronchial biopsy or in one case supraclavicular lymph node aspiration) or follow-up 88% 100% 100% 12.5% 98% 88% No complications Diagnosis of lymphoma Kennedy 30 Retrospective 25 patients with suspected lymphoma (clinical, radiological data or other previous lymphoma) Results of the biopsy and clinical and radiological follow-up of patients for 6 months 90.9% 100% 100% 92.6% 44% 96% No complications S: sensitivity; Sp: specificity; PPV: positive predictive value; NPV: negative predictive value; P: prevalence. #: For this calculation, four cases without definitive diagnosis were deemed positive.
Vol 33 Issue 5
Table of Contents
Effectiveness and safety of endobronchial ultrasound–transbronchial needle aspiration: a systematic review
