Endobronchial ultrasound-guided mediastinal biopsies for the diagnosis of mediastinal diseases: A network meta-analysis.
Yong-Jia Qi, Jing Zhang, Esperanza Salcedo Lobera et al.
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In 30 seconds
This network meta-analysis assessed the efficacy and safety of EBUS-guided biopsy strategies for mediastinal diseases, drawing on 15 prospective studies with 1,316 participants. Five approaches were evaluated: EBUS-TBNA, forceps biopsy, cryobiopsy, and combinations of EBUS-TBNA with either biopsy method. Adding EBUS-TBNA improved the efficacy of forceps biopsy and cryobiopsy. EBUS-TBNA plus cryobiopsy had the strongest diagnostic outcome, with higher odds than EBUS-TBNA alone (OR 4.01, 95% CrI 3.05-5.33). Safety profiles were similarly favourable across the methods.
Key findings
- EBUS-TBNA plus cryobiopsy had higher diagnostic odds than EBUS-TBNA alone (OR 4.01, 95% CrI 3.05-5.33).
- The combination also outperformed forceps biopsy (OR 2.75, 95% CrI 1.94-3.92), cryobiopsy (OR 1.80, 95% CrI 1.33-2.45), and EBUS-TBNA plus forceps biopsy (OR 1.81, 95% CrI 1.20-2.72).
- Concomitant EBUS-TBNA enhanced the efficacy of both forceps biopsy and cryobiopsy.
- All evaluated EBUS-based biopsy methods had a similarly favourable safety profile.
Why it matters
Mediastinal conditions beyond lung cancer staging may require tissue acquisition strategies that provide adequate diagnostic yield. This synthesis compares several EBUS-based approaches and suggests that combining EBUS-TBNA with cryobiopsy may improve diagnostic outcomes while retaining a favourable safety profile. The findings help clarify the relative performance of available methods, although they do not establish that one approach is appropriate for every mediastinal disease or clinical setting.
What to keep in mind
The analysis included 15 prospective studies, and the abstract does not report disease-specific results or further details on study comparability.