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Pulmonary Medicine
Volume 2016, Article ID 1024709, 11 pages
Review Article

Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis

1Facultad de Medicina, Universidad San Sebastián, Lientur 1457, Concepción 4080871, Chile
2Division of Internal Medicine, Complejo Asistencial Victor Rios Ruiz, Los Angeles, Chile
3Division of Pulmonary Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
4Division of Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
5Division of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
6Divisions of Thoracic Surgery and Interventional Pulmonary, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
7Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
8Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA
9Unidad de Neumologia Intervencional, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile

Received 29 June 2016; Revised 29 August 2016; Accepted 31 August 2016

Academic Editor: Kazuyoshi Kuwano

Copyright © 2016 Gonzalo Labarca et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Endobronchial ultrasound (EBUS) is a procedure that provides access to the mediastinal staging; however, EBUS cannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS) is used for complete staging. Objective. To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing mediastinal staging. Methods. Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with surgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses. We produced a meta-analysis including sensitivity, specificity, and likelihood ratio analysis. Results. Twelve primary studies (1515 patients) were included; two were randomized controlled trials (RCTs) and ten were prospective trials. The pooled sensitivity for combined EBUS + EUS was 87% (CI 84–89%) and the specificity was 99% (CI 98–100%). For EBUS + EUS performed with a single bronchoscope group, the sensitivity improved to 88% (CI 83.1–91.4%) and specificity improved to 100% (CI 99-100%). Conclusion. EBUS + EUS is a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy noted at stations that are not traditionally accessible with conventional EBUS.