Comparative diagnostic performance of advanced endoscopic techniques in suspected sarcoidosis: A systematic review and network meta-analysis.
Sheng-Ping Li, Yan Luo, Xin-Bin Liu et al.
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In 30 seconds
This Bayesian network meta-analysis compared diagnostic yield and safety across endoscopic tissue-sampling techniques for suspected sarcoidosis. It included 35 studies identified through searches of three databases up to 22 April 2025. Compared with transbronchial lung biopsy (TBLB), diagnostic yield was higher with EBUS-guided intranodal forceps biopsy (EBUS-IFB; RR 3.50, 2.14-5.84) and EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TMC; RR 3.52, 1.97-6.48). These techniques ranked highest, but the authors caution that evidence certainty is low.
Key findings
- Compared with TBLB, EBUS-IFB had higher diagnostic yield (RR 3.50, 2.14-5.84).
- Compared with TBLB, EBUS-TMC had higher diagnostic yield (RR 3.52, 1.97-6.48).
- SUCRA rankings were highest for EBUS-IFB (0.912) and EBUS-TMC (0.910); conventional techniques ranked lowest.
- All procedures had a favourable safety profile.
Why it matters
The analysis compares several minimally invasive sampling options and suggests that newer EBUS-guided techniques may improve diagnostic yield over TBLB. This may help frame diagnostic strategy when tissue confirmation is sought, while the low certainty of evidence means rankings should not be treated as definitive or as proof that one approach is best for every patient.
What to keep in mind
The authors report low certainty of evidence, limiting confidence in comparative rankings and conclusions.