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 studyPatients/procedures includedReference/comparison testDiagnostic performancePAdequate sampleSafety
SSpPPVNPV
Lee 18#Prospective91 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 performed93.8%100%100%96.9%42%92%
Wallace 19Prospective138 consecutive patients with known or suspected lung cancer on the basis of CT abnormality but no proven extrathoracic metastases Blinded comparisonPathological confirmation for positive results Surgical sampling by mediastinoscopy or thoracoscopy, open surgical exploration or 6–12 months of follow-upPET28%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 assessment106 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 comparisonEBUS–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#Retrospective152 procedures carried out in 152 patients with primary lung masses or/and mediastinal adenopathyCytology results in positive cases with or without surgical confirmation Mediastinoscopy, lung resection, CT, FDG–PET or metabolic activity99.1%100%100%97%74.3%95.4%No complications
Herth 17#Prospective97 patients highly suspicious for NSCLC with CT scans showing lymph nodes <1 cm and negative PET in mediastinumSurgical results in all patients89%100%100%98.9%9.2%
Monsó 22#Prospective67 patients with pulmonary neoplasms and mediastinal and/or lobular lymph nodes >5 mm on ultrasoundCytologyDiagnostic yield 92.5%55.2%87.8%No complications
Nakajima 14#Retrospective43 patients with suspected metastasis of lung cancer and lymph nodes ≥5 mm on CTCytology 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#Prospective502 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 cases94%100%11%98.2%93.5%No complications
Herth 16#Prospective100 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 NSCLCMediastinoscopy (15%) or thoracotomy (85%) with resection of mediastinal nodes in all patients92.3%100%96.3%17%100%No complications
Yasufuku 13#Prospective102 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 excludedThoracotomy 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–TBNA100%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#Prospective108 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 cases94.6%100%100%89.5%62.9%97.2%No complications
Rintoul 23#Prospective18 patients with suspected or known lung cancer and detection of nodular enlargement or presence of paratracheal or parabronchial masses on CTPositive 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#Prospective33 patients for staging of lung cancer (n = 20) or diagnosis of mediastinal lesions (n = 13)Thoracotomy (n = 9), clinical follow-up (n = 19)EBUS–TBNA93.9%95%No complications
85%100%72%
EUS–FNA
80%100%66%
Yasufuku 9#Prospective70 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.