Endobronchial ultrasound guided-transbronchial needle aspiration vs. conventional transbronchial needle aspiration in the diagnosis of mediastinal masses: A meta-analysis

Whether an endobronchial ultrasound (EBUS) is required for transbronchial needle aspiration (TBNA) in the diagnosis of mediastinal masses is currently a disputed subject. Previous studies have demonstrated that EBUS-TBNA performs better compared to conventional TBNA as it is capable of sampling in real-time compared with conventional TBNA. However, some clinicians consider conventional TBNA to be sufficient for diagnosis. In this meta-analysis, we evaluated these two methods according to diagnostic yield. A search was conducted through PubMed, Embase and the proceedings of major conferences, for studies comparing TBNA with EBUS-TBNA in the diagnosis of mediastinal masses. The identified studies were evaluated for publication bias and heterogeneity. The primary outcome was diagnostic yield. Pooled odds ratio (OR) estimated with 95% confidence intervals (CIs) was calculated using the fixed-effects model. Five studies, including a total of 407 patients, were included in the meta-analysis. The EBUS-TBNA arm was associated with a significantly higher OR compared to that of the TBNA arm in terms of diagnostic yield (OR=2.72, 95% CI: 1.72-4.30, P<0.001). There was no evidence of heterogeneity (I-2=0%, P=0.540) or publication bias (Egger's test, P=0.568; Begg-Mazumdar test, P=0.806). In conclusion, EBUS-TBNA and conventional TBNA are safe and provide good diagnostic yield in the diagnosis of hilar and mediastinal masses and lymphadenopathies; however, EBUS-TBNA performs better compared to conventional TBNA, with a shorter aspiration time and higher sensitivity.