Endoscopic ultrasound: it's accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review

Abstract

Aim: To evaluate the accuracy of endoscopic ultrasound (EUS), EUS-fine needle aspiration (FNA) in evaluating mediastinal lymphadenopathy.

Methods: Only EUS and EUS-FNA studies confirmed by surgery or with appropriate follow-up were selected. Articles were searched in Medline, Pubmed, and Cochrane control trial registry. Only studies from which a 2 multiply 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Pooling was conducted by both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights.

Results: Data was extracted from 76 studies (n = 9310) which met the inclusion criteria. Of these, 44 studies used EUS alone and 32 studies used EUS-FNA. FNA improved the sensitivity of EUS from 84.7% (95% CI: 82.9-86.4) to 88.0% (95% CI: 85.8-90.0). With FNA, the specificity of EUS improved from 84.6% (95% CI: 83.2-85.9) to 96.4% (95% CI: 95.3-97.4). The P for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10.

Conclusion: EUS is highly sensitive and specific for the evaluation of mediastinal lymphadenopathy and FNA substantially improves this. EUS with FNA should be the diagnostic test of choice for evaluating mediastinal lymphadenopathy.

Figure 1

The search results.

Figure 2

Forrest plots. A: Sensitivity of EUS alone in diagnosing mediastinal lymphadenopathy; B: Sensitivity of EUS-FNA in diagnosing mediastinal lymphadenopathy.

Figure 3

Forrest plots. A: Specificity of EUS alone in diagnosing mediastinal lymphadenopathy. B: Specificity of EUS-FNA alone in diagnosing mediastinal lymphadenopathy.

Figure 4

Forrest plot showing diagnostic odds ratio of EUS-FNA in identifying mediastinal lymphadenopathy.

Figure 5

SROC for EUS to diagnose mediastinal lymphadenopathy.

Figure 6

Funnel plots. A: Bias assessment for EUS studies without FNA in examining mediastinal lymphadenopathy; B: Bias assessment for EUS-FNA studies in examining mediastinal lymphadenopathy.