Efficacy and safety of convex probe EBUS-TBNA in sarcoidosis: A systematic review and meta-analysis

Background and aim: Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for diagnosis of mediastinal lymphadenopathy. Although most studies have reported the utility of EBUS-TBNA in malignancy, its use has been extended to benign conditions including sarcoidosis. Herein, we perform a systematic review and meta-analysis of studies reporting the diagnostic yield and safety of EBUS-TBNA in sarcoidosis. Methods: We searched the PubMed and EmBase databases for relevant studies published from 2004 to 2011, and included studies that have reported the diagnostic yield of EBUS-TBNA in sarcoidosis. The quality of studies was assessed using the QualSyst tool. We calculated the proportions with 95% confidence interval (Cl) to assess the diagnostic yield of EBUS-TBNA in individual studies and then pooled the results using a random effects model. Heterogeneity was assessed using the I-2 and Cochran-Q tests while publication bias was assessed using both graphical and statistical methods. Results: Our search yielded 15 studies (553 patients of sarcoidosis). The diagnostic yield of EBUS-TBNA ranged from 54 to 93% with the pooled diagnostic accuracy being 79% (95% CI, 71-86%) by the random effects model. The yield was not statistically different in studies employing on-site cytological evaluation (80.1%) vs. those without (81.3%). However, the diagnostic yield was significantly higher in prospective studies (83.9%) vs. the retrospective studies (74.3%). Only five minor complications were reported in 553 patients. There was evidence of heterogeneity and publication bias. Conclusions: EBUS-TBNA is a safe and efficacious procedure in the diagnosis of sarcoidosis, and should be routinely employed wherever available. (C) 2012 Elsevier Ltd. All rights reserved.