Diagnostic Accuracy of Endobronchial Ultrasound Transbronchial Needle Aspiration in Lymphoma. A Systematic Review and Meta-Analysis.

Rationale: Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive method used to diagnose suspected mediastinal lymph nodes or masses. However, the accuracy of the diagnosis in patients with suspected lymphoma is unclear.Objectives: To evaluate the diagnostic yield of EBUS-TBNA in patients with suspected lymphoma.Methods: A literature search including EMBASE, MEDLINE, Cochrane Library, and Google Scholar was performed by two reviewers. Included articles were evaluated using the QUADAS-2 tool and meta-analysis with a binary method model to compare the sensitivity, specificity, and summary receiver operating characteristic curve in patients with suspected lymphoma.Results: Fourteen studies (425 participants) were pooled in the analysis. EBUS-TBNA reported an overall sensitivity of 66.2% (confidence interval [CI], 55-75.8%; I2 = 76.2%) and specificity of 99.3% (CI, 98.2-99.7%; I2 = 40%). For a new diagnosis of lymphoma, 13 studies including 243 participants reported sensitivity of 67.1% (CI, 54.2-77.9%; I2 = 66.8%) and specificity of 99.6% (CI, 99.1-99.8%; I2 = 0%). For recurrence of lymphoma, 11 studies including 166 participants reported sensitivity of 77.8% (CI, 68.1-85.2%; I2 = 20.2%) and specificity of 99.5% (CI, 98.9-99.8%; I2 = 0%). In the recurrence group, we found the use of rapid onsite examination, sample size, and flow cytometry increased the sensitivity of EBUS-TBNA, albeit a potential source of heterogeneity.Conclusions: EBUS-TBNA has fair sensitivity for identifying a new diagnosis of lymphoma and fair to good sensitivity for identifying recurrence.Trial Registry: PROSPERO CRD42018102773 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=102773.