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Efficacy and safety of EBUS‐TBNA and EUS‐B‐FNA in children: A systematic review and meta‐analysis
Author(s) -
Madan Karan,
Iyer Hariharan,
Madan Neha K.,
Mittal Saurabh,
Tiwari Pawan,
Hadda Vijay,
Mohan Anant,
Pandey Ravindra M.,
Kabra Sushil K.,
Guleria Randeep
Publication year - 2021
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.25124
Subject(s) - medicine , meta analysis , radiology , fine needle aspiration , complication , confidence interval , sampling (signal processing) , population , biopsy , surgery , environmental health , filter (signal processing) , computer science , computer vision
Background Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) and transesophageal bronchoscopic ultrasound‐guided fine‐needle aspiration (EUS‐B‐FNA) are established modalities for evaluation of mediastinal/hilar lymphadenopathy in adults. Limited literature is available on the utility of these modalities in the pediatric population. Herein, we perform a systematic review and meta‐analysis on the yield and safety of EBUS‐TBNA and EUS‐B‐FNA in children. Methods We performed a systematic search of the PubMed and EMBASE databases to extract the studies reporting the utilization of EBUS‐TBNA/EUS‐B‐FNA in children (<18 years of age). The pooled diagnostic yield and sampling adequacy (proportions with 95% confidence intervals [CIs]) were calculated using meta‐analysis of proportions using the random effects model. Details of any procedure‐related complications were noted. Results The search yielded 12 relevant studies (5 case series and 7 case reports on EBUS‐TBNA/EUS‐B‐FNA, 173 patients). Data from five case series (164 patients) were summarized for the calculation of the sampling adequacy and diagnostic yield. Safety outcomes were extracted from all publications. The pooled sampling adequacy and combined diagnostic yield of EBUS TBNA/EUS‐B‐FNA were 98% (95% CI, 92%–100%) and 61% (95% CI, 43%–77%), respectively. A procedure‐related major complication was reported in one patient (1/173, a major complication rate of 0.6%), and minor complications occurred in six patients (6/173, a minor complication rate of 3.5%). Conclusions EBUS‐TBNA and EUS‐B‐FNA are safe modalities for evaluation of mediastinal lymphadenopathy in the pediatric population. EBUS‐TBNA/EUS‐B‐FNA may be considered as the first‐line diagnostic modalities for this indication, as they have a good diagnostic yield and can avoid the need for invasive diagnostic procedures.