Meta-analysis and systematic review of mediastinal cryobiopsy versus endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of intrathoracic adenopathy.

IF 2.1 3区医学 Q3 RESPIRATORY SYSTEM

Journal of thoracic disease Pub Date : 2024-07-30 Epub Date: 2024-07-18 DOI:10.21037/jtd-24-348

Roshen Mathew, Winnie Elma Roy, Elizabel Susan Thomas, Nikhil Meena, Olesya Danilevskaya

{"title":"Meta-analysis and systematic review of mediastinal cryobiopsy versus endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of intrathoracic adenopathy.","authors":"Roshen Mathew, Winnie Elma Roy, Elizabel Susan Thomas, Nikhil Meena, Olesya Danilevskaya","doi":"10.21037/jtd-24-348","DOIUrl":null,"url":null,"abstract":"Background: Endobronchial ultrasound (EBUS)-guided mediastinal/hilar cryobiopsy (MedCryoBx) is a relatively new modality, being combined with EBUS-transbronchial needle aspiration (TBNA) to improve yield in the diagnosis of intrathoracic adenopathy. This meta-analysis aims to investigate the diagnostic yield of MedCryoBx versus EBUS-TBNA for intrathoracic adenopathy.Methods: We conducted a systematic search using Google Scholar, Embase, and PubMed/MEDLINE for studies about a diagnosis of intrathoracic adenopathy using MedCryoBx and EBUS-TBNA. Two authors separately reviewed studies for inherent bias using the Quality Assessment Data Abstraction and Synthesis-2 (QUADAS-2) tool. Inverse Variance weighting for random effects methodology was used for meta-analysis. Pooled diagnostic yields overall and for subgroups were estimated. Complications of MedCryoBx were reviewed.Results: Ten studies with 844 patients undergoing either biopsy procedure were in the final analysis. A total of 554 patients underwent MedCryoBx and 704 patients EBUS-TBNA. Meta-analysis showed a pooled diagnostic yield of 91% (504 of 554) for MedCryoBx and 81% (567 of 704) for EBUS-TBNA, with odds ratio (OR) of 2.5 [95% confidence interval (CI): 1.6 to 3.91; P<0.001], with I2 of 20%. Subgroup analysis for benign conditions showed increased diagnostic yield with OR of 7.95 (91% MedCryoBx versus 58% EBUS-TBNA, P<0.001) with an I2 of 25%. Subgroup analysis for lymphoma showed a statistically significant increase in pooled diagnostic yield with OR of 11.48 (87% MedCryoBx versus 29% EBUS-TBNA, P=0.001). Mild bleeding (36.5%) without any intervention was the most common complication. Bleeding requiring intervention (0.7%) was noted in patients. Pneumothorax (0.4%) and pneumomediastinum (0.4%) were less common in this analysis.Conclusions: MedCryoBx is a very promising tool for the diagnosis of intrathoracic adenopathy. It has improved diagnostic yield over EBUS-TBNA in benign and possibly lymphoproliferative diseases, but less so in lung cancer. The complication rates with MedCryoBx are comparable to EBUS-TBNA.","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320235/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of thoracic disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/jtd-24-348","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/18 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Endobronchial ultrasound (EBUS)-guided mediastinal/hilar cryobiopsy (MedCryoBx) is a relatively new modality, being combined with EBUS-transbronchial needle aspiration (TBNA) to improve yield in the diagnosis of intrathoracic adenopathy. This meta-analysis aims to investigate the diagnostic yield of MedCryoBx versus EBUS-TBNA for intrathoracic adenopathy.

Methods: We conducted a systematic search using Google Scholar, Embase, and PubMed/MEDLINE for studies about a diagnosis of intrathoracic adenopathy using MedCryoBx and EBUS-TBNA. Two authors separately reviewed studies for inherent bias using the Quality Assessment Data Abstraction and Synthesis-2 (QUADAS-2) tool. Inverse Variance weighting for random effects methodology was used for meta-analysis. Pooled diagnostic yields overall and for subgroups were estimated. Complications of MedCryoBx were reviewed.

Results: Ten studies with 844 patients undergoing either biopsy procedure were in the final analysis. A total of 554 patients underwent MedCryoBx and 704 patients EBUS-TBNA. Meta-analysis showed a pooled diagnostic yield of 91% (504 of 554) for MedCryoBx and 81% (567 of 704) for EBUS-TBNA, with odds ratio (OR) of 2.5 [95% confidence interval (CI): 1.6 to 3.91; P<0.001], with I² of 20%. Subgroup analysis for benign conditions showed increased diagnostic yield with OR of 7.95 (91% MedCryoBx versus 58% EBUS-TBNA, P<0.001) with an I² of 25%. Subgroup analysis for lymphoma showed a statistically significant increase in pooled diagnostic yield with OR of 11.48 (87% MedCryoBx versus 29% EBUS-TBNA, P=0.001). Mild bleeding (36.5%) without any intervention was the most common complication. Bleeding requiring intervention (0.7%) was noted in patients. Pneumothorax (0.4%) and pneumomediastinum (0.4%) were less common in this analysis.

Conclusions: MedCryoBx is a very promising tool for the diagnosis of intrathoracic adenopathy. It has improved diagnostic yield over EBUS-TBNA in benign and possibly lymphoproliferative diseases, but less so in lung cancer. The complication rates with MedCryoBx are comparable to EBUS-TBNA.

查看原文本刊更多论文

纵隔冷冻活检与支气管内超声-经支气管针吸术（EBUS-TBNA）在胸腔内腺体病诊断中的荟萃分析和系统回顾。

背景：支气管内超声（EBUS）引导下纵隔/肺门冷冻活检（MedCryoBx）是一种相对较新的方法，它与EBUS-经支气管针吸术（TBNA）相结合，可提高胸内腺病的诊断率。本荟萃分析旨在研究 MedCryoBx 与 EBUS-TBNA 对胸内腺病的诊断率：我们使用 Google Scholar、Embase 和 PubMed/MEDLINE 对使用 MedCryoBx 和 EBUS-TBNA 诊断胸内腺病的研究进行了系统检索。两位作者分别使用质量评估数据抽取与综合-2（QUADAS-2）工具对研究进行了审查，以确定是否存在固有偏倚。荟萃分析采用随机效应反方差加权法。对总体和亚组的汇总诊断率进行了估算。对 MedCryoBx 的并发症进行了回顾：最终分析了10项研究，共有844名患者接受了其中一种活检术。共有 554 名患者接受了 MedCryoBx，704 名患者接受了 EBUS-TBNA。元分析显示，MedCryoBx 的综合诊断率为 91%（554 例中的 504 例），EBUS-TBNA 为 81%（704 例中的 567 例），几率比 (OR) 为 2.5 [95% 置信区间 (CI)：1.6 至 3.91；P2 为 20%]。良性疾病的亚组分析显示诊断率有所提高，OR 为 7.95（91% 的 MedCryoBx 与 58% 的 EBUS-TBNA，P2 为 25%）。淋巴瘤亚组分析显示，汇总诊断率有统计学意义的显著提高，OR 为 11.48（87% MedCryoBx 对 29% EBUS-TBNA，P=0.001）。最常见的并发症是轻微出血（36.5%），无需介入治疗。需要介入治疗的出血患者占 0.7%。在这项分析中，气胸（0.4%）和气胸（0.4%）较少见：结论：MedCryoBx 是一种非常有前途的诊断胸腔内腺体病的工具。结论：MedCryoBx 是一种非常有前途的诊断胸腔内腺体病的工具，与 EBUS-TBNA 相比，它能提高良性疾病和可能的淋巴增生性疾病的诊断率，但对肺癌的诊断率较低。MedCryoBx 的并发症发生率与 EBUS-TBNA 不相上下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of thoracic disease RESPIRATORY SYSTEM-

CiteScore

4.60

自引率

4.00%

发文量

254

期刊介绍： The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.