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

Table 1

Primary studies included and their characteristics.

Author	Year	Sample	Patient	Image study	Index test	Outcome	Reference standard	Comments
Vilmann et al. [13]	2005	31	Lung cancer staging or suspected lung cancer	CT scan with suspected mass or lymph node	EBUS-TBNA + EUS-FNA	Lung cancer staging or diagnosis	Thoracotomy or clinical followup	Prospective trial, non-RCT. 9 patients underwent thoracotomy and 19 had clinical followup.
Wallace et al. [14]	2008	138	Lung cancer staging or suspected lung cancer	CT scan and PET CT with enlarged and/or PET positive lymph nodes	EBUS-TBNA + EUS-FNA	Lung cancer staging or diagnosis	Thoracotomy, mediastinoscopy, lobectomy, and thoracoscopy	Prospective trial, non-RCT. 33 patients underwent thoracotomy, 4 mediastinoscopy, 4 lobectomy, and 1 thoracoscopy. The rest had 6–12-month clinical followup.
Annema et al. [15]	2010	241	Lung cancer staging, resectable	CT scan and PET CT with enlarged and/or PET positive lymph nodes	EBUS-TBNA + EUS-FNA	Lung cancer staging	Mediastinoscopy and/or thoracotomy	RCT, 1 : 1. One arm to endoscopic staging and one arm to surgical staging. Standard reference for this study included thoracotomy in patients without positive endosonography.
Herth et al. [16]	2010	139	Lung cancer staging or suspected lung cancer	CT scan, PET CT in some patients	EBUS-TBNA and EUS-B-FNA	Lung cancer staging	Thoracoscopy, thoracotomy, or clinical followup to 12 months	Prospective study, non-RCT. Timing flow since inclusion is 6–12 months.
Hwangbo et al. [17]	2010	150	Lung cancer staging or suspected lung cancer	CT scan and PET CT with enlarged and/or PET positive lymph nodes	EBUS-TBNA and EUS-B-FNA	Lung cancer staging	Surgery, lymph node dissection	Prospective trial, non-RCT.
Szlubowski et al. [18]	2010	120	Lung cancer staging, stage IA-IIB	CT scan with normal size lymph nodes	EBUS-TBNA + EUS-FNA	Lung cancer staging	Bilateral transcervical extended mediastinal lymphadenectomy	Prospective trial, non-RCT. Patients with negative EBUS/EUS underwent bilateral transcervical extended mediastinal lymphadenectomy.
Ohnishi et al. [19]	2011	110	Staging for suspected resectable lung cancer	CT scan and PET CT with enlarged and/or PET positive lymph nodes	EBUS-TBNA + EUS-FNA	Lung cancer staging	Surgery without any specification	Prospective trial, non-RCT.
Szlubowski et al. [20]	2012	214	Lung cancer staging, stage 1A-IIIB	CT scan	EBUS-TBNA and EUS-B-FNA	Lung cancer staging	Systematic lymph node dissection	Prospective trial, non-RCT. 110 EBUS + EUS and 104 EBUS + EUS-B-FNA.
Kang et al. [21]	2014	148	Staging for confirmed or suspected resectable lung cancer	CT scan and PET CT with enlarged and/or PET positive lymph nodes	EBUS-TBNA and EUS-B-FNA	Lung cancer staging	Surgery without any specification	RCT, 1 : 1. EBUS centered arm versus EUS centered arm using the same bronchoscope. Patients without definitive data were excluded for sensitivity analysis.
Lee et al. [22]	2014	44	Staging for confirmed or suspected lung cancer	PET CT without M1 disease	EBUS-TBNA and EUS-B-FNA	Lung cancer staging	Mediastinoscopy or lymph node resection	Retrospective analysis. 4 patients underwent mediastinoscopy and 4 underwent lymph node resection.
Liberman et al. [23]	2014	144	Staging for confirmed or suspected resectable lung cancer	CT scan and PET CT with enlarged and/or PET positive lymph nodes	EBUS-TBNA + EUS-FNA	Lung cancer staging	Mediastinoscopy or lymph node dissection	Prospective trial, non-RCT. AS per protocol, patients underwent surgical staging following endosonographic staging.
Oki et al. [24]	2014	150	Staging for confirmed or suspected resectable lung cancer	CT scan and PET CT	EBUS-TBNA and EUS-B-FNA	Lung cancer staging	Surgical resection with lymph node dissection or clinical followup	Prospective trial, non-RCT. 5 patients were excluded from analysis without clinical followup. Clinical followup was 6 months after the procedure.