Diagnostic value of convex probe endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal tuberculous lymphadenitis: A systematic review and meta-analysis

Abstract

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been widely used in the diagnosis of mediastinal lymphadenopathies. Here, we performed a systematic review and meta-analysis to explore the diagnostic value of EBUS-TBNA in mediastinal tuberculous lymphadenopathy (TBLA). Material/Methods: PubMed, EMBASE, and Sinoced were systematically searched for articles published in English or Chinese that reported the diagnostic yield of EBUS-TBNA in mediastinal TBLA. The quality of studies was assessed using the QualSyst tool. Using 95% confdence intervals (CI), the diagnostic yields of EBUS-TBNA were calculated for the individual studies, and the results were then pooled using a random-efects model. Heterogeneity and publication bias were also assessed. Results: A total of 14 studies, consisting of 684 patients with mediastinal TBLA, were fnally included. The pooled diagnostic yield of EBUS-TBNA for mediastinal TBLA was 80% (95% CI: 74–86%). Signifcant heterogeneity (I2=77.9%) and signifcant publication bias were detected (Begg’s test p=0.05 and Egger’s test p=0.02). From subgroup analyses, signifcant diferences in the diagnostic yield of EBUS-TBNA were associated with Asian vs. European (UK) studies, retrospective vs. prospective studies, those employing rapid on-site cytological evaluation vs. not, those employing diferent anesthetic types, and those employing smear vs. culture. However, microbiological examination and the number of lymph node passes did not have a signifcant efect on the diagnostic yield of EBUS-TBNA. Fifteen minor complications for EBUS-TBNA were reported. Conclusions: EBUS-TBNA appears to be an efcacious and safe procedure and should be used as an initial diagnostic tool for mediastinal TBLA.