Study | Reference standard | Test order | Patients n | Prevalence N2/N3 % | EBUS | EUS | EBUS+EUS | |||
Sensitivity (95% CI) | NPV (95% CI) | Sensitivity (95% CI) | NPV (95% CI) | Sensitivity (95% CI) | NPV (95% CI) | |||||
Vilmann [31], 2005 | Surgery: Pulmonary resection with lymph node exploration Clinical follow-up | EUS–EBUS | 28 | 71 | 0.85 (0.62–0.97) | 0.72 (0.39–0.94) | 0.80 (0.56–0.94) | 0.67 (0.35–0.90) | 1.00 (0.83–1.00) | 1.00 (0.63–1.00) |
Wallace [32], 2008 | Surgery: Pulmonary resection with mediastinal exploration Mediastinoscopy Thoracoscopy Clinical follow-up | EBUS–EUS | 138 | 30 | 0.69 (0.53–0.82) | 0.88 (0.80–0.93) | 0.69 (0.53–0.82) | 0.88 (0.80–0.93) | 0.93 (0.81–0.99) | 0.97 (0.91–0.99) |
Annema [18], 2010 | Surgery: Pulmonary resection with node dissection | EUS–EBUS | 123 | 54 | – | – | – | – | 0.85 (0.74–0.92) | 0.85 (0.74–0.93) |
Herth [33], 2010 | Surgery: Thoracoscopy Pulmonary resection with node dissection Clinical follow-up | EBUS–EUS-B | 139 | 52 | 0.92 (0.83–0.97) | 0.92 (0.83–0.97) | 0.89 (0.79–0.95) | 0.89 (0.80–0.95) | 0.96 (0.88–0.99) | 0.96 (0.88–0.99) |
Hwangbo [34], 2010 | Surgery: Pulmonary resection node dissection | EBUS–EUS-B | 143 | 31 | 0.84 (0.71–0.94) | 0.93 (0.87–0.97) | – | – | 0.91 (0.79–0.98) | 0.96 (0.90–0.99) |
Szlubowski [35], 2010 | Surgery: Pulmonary resection with node dissection TEMLA | EUS–EBUS | 120 | 23 | 0.46 (0.28–0.66) | 0.86 (0.78–0.92) | 0.50 (0.31–0.69) | 0.87 (0.79–0.93) | 0.68 (0.48–0.84) | 0.91 (0.83–0.96) |
Ohnishi [36], 2011 | Surgery: Pulmonary resection with nodal exploration | EBUS–EUS | 110 | 28 | – | – | – | – | 0.84 (0.71–0.97) | 0.94 (0.89–0.99) |
Kang [37], 2014 | Surgery: Pulmonary resection with node dissection Video-assisted thoracic surgery | EBUS–EUS-B | 74 | 46 | – | – | – | – | 0.84 (0.66–0.95) | 0.94 (0.87–0.98) |
Kang [37], 2014 | Surgery: Pulmonary resection with node dissection Video-assisted thoracic surgery | EUS-B–EBUS | 74 | 34 | 0.82 (0.65–0.93) | 0.87 (0.74–0.95) | – | – | 0.85 (0.69–0.95) | 0.89 (0.76–0.96) |
Lee [38], 2014 | Surgery: Mediastinoscopy Pulmonary resection with mediastinal node dissection | EBUS–EUS-B | 37 | 78 | 0.79 (0.60–0.92) | 0.57 (0.29–0.82) | – | – | 1.00 (0.88–1.00) | 1.00 (0.63–1.00) |
Liberman [39], 2014 | Surgery: Mediastinoscopy (no pulmonary resection with nodal exploration/dissection) | EBUS–EUS | 166 | 32 | 0.72 (0.58–0.83) | 0.88 (0.81–0.93) | 0.62 (0.48–0.75) | 0.85 (0.78–0.91) | 0.91 (0.79–0.97) | 0.96 (0.90–0.99) |
Oki [40], 2014 | Surgery: Pulmonary resection with node exploration/ dissection Clinical follow-up | EBUS–EUS-B | 146 | 23 | 0.52 (0.34–0.69) | 0.88 (0.81–0.93) | 0.45 (0.28–0.64) | 0.86 (0.79–0.92) | 0.73 (0.54–0.87) | 0.93 (0.86–0.97) |
NPV: negative predictive value; EUS-B: endoscopic (oesophageal) ultrasound using the EBUS scope; TEMLA: transcervical extended bilateral mediastinal lymph adenectomy.