Lung

, Volume 193, Issue 5, pp 757–766 | Cite as

Comparison of Endobronchial Ultrasound-Guided Fine Needle Aspiration and Video-Assisted Mediastinoscopy for Mediastinal Staging of Lung Cancer

Article

Abstract

Video-assisted mediastinoscopy (VAM) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are the two most commonly used invasive methods for mediastinal staging of lung cancer. The objective of this review is to assess and compare the overall diagnostic values of VAM and EBUS-TBNA. PubMed, Embase, Web of Science and the Cochrane Library were searched for studies that evaluated EBUS-TBNA or VAM accuracy. Quantitative meta-analysis was used to pool sensitivity and specificity, and study quality was evaluated. Meta-regression was applied to indirectly compare EBUS-TBNA and VAM after adjusting quality score, study design, and station number. A total of ten studies with 999 EBUS-TBNA patients and seven studies with 915 VAM patients were included. Since the pooled specificity was 100 % for both modalities, sensitivity was mainly analyzed. The pooled sensitivities for EBUS-TBNA and VAM were 0.84 (95 % CI 0.79–0.88) and 0.86 (95 % CI 0.82–0.90), respectively. Subgroup analyses of quality score, study design, station number and rapid on-site cytologic evaluation showed no significant influence on the overall sensitivity of the two modalities. After adjusting quality score, study design, and station number, the pooled sensitivities of VAM and EBUS-TBNA were not significantly different. However, more procedural complications and fewer false negatives (FN) were found with VAM than EBUS-TBNA. VAM and EBUS exhibited equally high diagnostic accuracy for mediastinal staging of lung cancer. Due to lower morbidity with EBUS-TBNA and fewer FN with VAM, EBUS-TBNA should be performed first, followed by VAM in the case of a negative needle result.

Keywords

Lung neoplasms Endobronchial ultrasound-guided transbronchial needle aspiration Video-assisted mediastinoscopy Diagnostic value 

Abbreviations

VAM

Video-assisted mediastinoscopy

EBUS-TBNA

Endobronchial ultrasound-guided transbronchial needle aspiration

ROSE

Rapid on-site cytologic evaluation

FN

False negatives

CT

Computed tomography

PET

Positron emission tomography

EUS-FNA

Transesophageal ultrasound-guided fine needle aspiration

TP

True-positive

FP

False-positive

TN

True-negative

NLR

Negative likelihood ratio

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflict of interest.

References

  1. 1.
    Siegel R, Ma JM, Zou ZH et al (2014) Cancer statistics. CA Cancer J Clin 64:9–29CrossRefPubMedGoogle Scholar
  2. 2.
    Fibla JJ, Molins L, Simon C et al (2006) The yield of mediastinoscopy with respect to lymph node size, cell type, and the location of the primary tumor. J Thorac Oncol 1:430–433CrossRefPubMedGoogle Scholar
  3. 3.
    Dillemans B, Deneffe G, Verschakelen J et al (1994) Value of computed tomography and mediastinoscopy in preoperative evaluation of mediastinal nodes in non-small cell lung cancer. A study of 569 patients. Eur J Cardiothorac Surg 8:37–42CrossRefPubMedGoogle Scholar
  4. 4.
    Hammoud ZT, Anderson RC, Meyers BF et al (1999) The current role of mediastinoscopy in the evaluation of thoracic disease. J Thorac Cardiovasc Surg 118:894–899CrossRefPubMedGoogle Scholar
  5. 5.
    Coughlin M, Deslauriers J, Beaulieu M et al (1985) Role of mediastinoscopy in pretreatment staging of patients with primary lung cancer. Ann Thorac Surg 40:556–560CrossRefPubMedGoogle Scholar
  6. 6.
    Zhang R, Mietchen C, Krüger M et al (2012) Endobronchial ultrasound guided fine needle aspiration versus transcervical mediastinoscopy in nodal staging of non small cell lung cancer: a prospective comparison study. J Cardiothorac Surg 7:51PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Whiting P, Rutjes AW, Reitsma JB et al (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Zamora J, Abraira V, Muriel A et al (2006) Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 6:31PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Lee BE, Kletsman E, Rutledge JR et al (2012) Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with non-small cell lung cancer. J Thorac Cardiovasc Surg 143:585–590CrossRefPubMedGoogle Scholar
  10. 10.
    Lee HS, Lee GK, Lee HS et al (2008) Real-time Endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer. how many aspirations per target lymph node station? Chest 134:368–374CrossRefPubMedGoogle Scholar
  11. 11.
    Oki M, Saka H, Ando M et al (2014) Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: are two better than one in mediastinal staging of non-small cell lung cancer? J Thorac Cardiovasc Surg 148:1169–1177CrossRefPubMedGoogle Scholar
  12. 12.
    Hwangbo B, Lee GK, Lee HS et al (2010) Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest 138:795–802CrossRefPubMedGoogle Scholar
  13. 13.
    Kang HJ, Hwangbo B, Lee GK et al (2014) EBUS-centred versus EUS-centred mediastinal staging in lung cancer: a randomised controlled trial. Thorax 69:261–268CrossRefPubMedGoogle Scholar
  14. 14.
    Clementsen PF, Skov BG, Vilmann P et al (2014) Endobronchial ultrasound-guided biopsy performed under optimal conditions in patients with known or suspected lung cancer may render mediastinoscopy unnecessary. J Bronchology Interv Pulmonol 21:21–25CrossRefPubMedGoogle Scholar
  15. 15.
    Hwangbo B, Kim SK, Lee HS et al (2009) Application of endobronchial ultrasound-guided transbronchial needle aspiration following integrated PET/CT in mediastinal staging of potentially operable non-small cell lung cancer. Chest 135:1280–1287CrossRefPubMedGoogle Scholar
  16. 16.
    Yasufuku K, Pierre A, Darling G et al (2011) A prospective controlled trial of endobronchial ultrasound guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. J Thorac Cardiovasc Surg 142:1393–1400CrossRefPubMedGoogle Scholar
  17. 17.
    Yasufuku K, Nakajima T, Motoori K et al (2006) Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer. Chest 130:710–718CrossRefPubMedGoogle Scholar
  18. 18.
    Lardinois D, Schallberger A, Betticher D et al (2003) Postinduction video-mediastinoscopy is as accurate and safe as video-mediastinoscopy in patients without pretreatment for potentially operable non-small cell lung cancer. Ann Thorac Surg 75:1102–1106CrossRefPubMedGoogle Scholar
  19. 19.
    Kimura H, Iwai N, Ando S et al (2003) A prospective study of indications for mediastinoscopy in lung cancer with CT findings, tumor size, and tumor markers. Ann Thorac Surg 75:1734–1739CrossRefPubMedGoogle Scholar
  20. 20.
    Sayar A, Citak N, Metin M et al (2011) Comparison of video-assisted mediastinoscopy and video-assisted mediastinoscopic lymphadenectomy for lung cancer. Gen Thorac Cardiovasc Surg 59:793–798CrossRefPubMedGoogle Scholar
  21. 21.
    Kimura H, Yasufukub K, Andoa S et al (2007) Indications for mediastinoscopy and comparison of lymph node dissections in candidates for lung cancer surgery. Lung Cancer 56:349–355CrossRefPubMedGoogle Scholar
  22. 22.
    Venissac N, Alifano M, Mouroux J (2003) Video-assisted mediastinoscopy: experience from 240 consecutive cases. Ann Thorac Surg 76:208–212CrossRefPubMedGoogle Scholar
  23. 23.
    Anraku M, Miyata R, Compeau C et al (2010) Video-assisted mediastinoscopy compared with conventional mediastinoscopy: are we doing better? Ann Thorac Surg 89:1577–1581CrossRefPubMedGoogle Scholar
  24. 24.
    Silvestri CA, Gonzalez AV, Jantz MA et al (2013) Methods for staging non-small cell lung cancer diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(Suppl):e211S–e250SCrossRefPubMedGoogle Scholar
  25. 25.
    Kambartel K, Krbek T, Voshaar T (2012) Comparison of endobronchial ultrasound (EBUS) and mediastinoscopy (MS) for staging lung cancer. Pneumologie 66:426–431CrossRefPubMedGoogle Scholar
  26. 26.
    Ernst A, Anantham D, Eberhardt R et al (2008) Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy. J Thorac Oncol 3:577–582CrossRefPubMedGoogle Scholar
  27. 27.
    Song F, Altman DG, Glenny AM et al (2003) Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta-analyses. BMJ 326:472PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Bucher HC, Guyatt GH, Griffith LE et al (1997) The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol 50:683–691CrossRefPubMedGoogle Scholar
  29. 29.
    Purkayastha S, Athanasiou T, Tekkis PP et al (2006) Magnetic resonance colonography vs computed tomography colonography for the diagnosis of colorectal cancer: an indirect comparison. Colorectal Dis 9:100–111CrossRefGoogle Scholar
  30. 30.
    Herth FJ, Krasnik M, Kahn N et al (2010) Combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest 138:790–794CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Respiratory MedicineXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiPeople’s Republic of China
  2. 2.Department of PathologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiPeople’s Republic of China
  3. 3.Department of Health StatisticsSecond Military Medical UniversityShanghaiPeople’s Republic of China

Personalised recommendations