Abstract：
BACKGROUND: Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC), a novel technique, has been reported to improve the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal lesions in recent studies. Current literature suggests that this procedure has greater diagnostic efficacy compared to conventional EBUS-TBNA. This systematic review and meta-analysis aimed to evaluate the diagnostic yield and complications associated with EBUS-TMC in comparison to EBUS-TBNA, thereby exploring the potential of this novel technique in enhancing the diagnostic utility for mediastinal lesions.
METHODS: A comprehensive literature review was conducted by searching the PubMed, Embase, and Google Scholar databases for articles published from inception to December 31, 2023. The objective of this review was to evaluate the utilization of EBUS-TMC in diagnosing mediastinal disease, while also assessing the quality of each study using the QUADAS-2 tool. The diagnostic yield estimates were subjected to a meta-analysis utilizing inverse variance weighting. Furthermore, a comprehensive analysis of the complications associated with this procedure was performed.
RESULTS: The meta-analysis included 10 studies involving a total of 538 patients. The findings of the meta-analysis demonstrated that EBUS-TMC yielded an overall diagnostic rate of 89.59% (482/538), while EBUS-TBNA yielded a rate of 77.13% (415/538). The calculated inverse variance-weighted odds ratio was 2.63 (95% confidence interval, 1.86-3.72; p < 0.0001), and I2 value was 11%, indicating a statistically significant difference between the two techniques. The associated complications consisted of pneumothorax, pneumomediastinum, mediastinitis, and bleeding, with an incidence of 0.74% (4/538), 0.37% (2/538), 0.0% (0/538), and 1.12% (6/538), respectively. Moreover, the funnel plot displayed no discernible publication bias. Further subgroup analysis revealed a notable improvement in the diagnosis value for lymphoma (86.36% vs. 27.27%, p = 0.0006) and benign disorder (87.62% vs. 60.00%, p < 0.0001).
CONCLUSIONS: This review of the current available studies indicated that EBUS-TMC enhanced overall diagnostic yields compared to EBUS-TBNA, particularly for diagnosing benign disease and lymphoma. This procedure was not associated with any serious complications.
METHODS: A comprehensive literature review was conducted by searching the PubMed, Embase, and Google Scholar databases for articles published from inception to December 31, 2023. The objective of this review was to evaluate the utilization of EBUS-TMC in diagnosing mediastinal disease, while also assessing the quality of each study using the QUADAS-2 tool. The diagnostic yield estimates were subjected to a meta-analysis utilizing inverse variance weighting. Furthermore, a comprehensive analysis of the complications associated with this procedure was performed.
RESULTS: The meta-analysis included 10 studies involving a total of 538 patients. The findings of the meta-analysis demonstrated that EBUS-TMC yielded an overall diagnostic rate of 89.59% (482/538), while EBUS-TBNA yielded a rate of 77.13% (415/538). The calculated inverse variance-weighted odds ratio was 2.63 (95% confidence interval, 1.86-3.72; p < 0.0001), and I2 value was 11%, indicating a statistically significant difference between the two techniques. The associated complications consisted of pneumothorax, pneumomediastinum, mediastinitis, and bleeding, with an incidence of 0.74% (4/538), 0.37% (2/538), 0.0% (0/538), and 1.12% (6/538), respectively. Moreover, the funnel plot displayed no discernible publication bias. Further subgroup analysis revealed a notable improvement in the diagnosis value for lymphoma (86.36% vs. 27.27%, p = 0.0006) and benign disorder (87.62% vs. 60.00%, p < 0.0001).
CONCLUSIONS: This review of the current available studies indicated that EBUS-TMC enhanced overall diagnostic yields compared to EBUS-TBNA, particularly for diagnosing benign disease and lymphoma. This procedure was not associated with any serious complications.
摘要：
背景：支气管内超声引导下经支气管纵隔冷冻活检（EBUS-TMC），一种新颖的技术，在最近的研究中，有报道可以提高支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）对纵隔病变的诊断价值。目前的文献表明，与常规EBUS-TBNA相比，该方法具有更大的诊断功效。本系统评价和荟萃分析旨在评估EBUS-TMC与EBUS-TBNA相比的诊断率和并发症。从而探索这种新技术在增强纵隔病变诊断实用性方面的潜力。
方法：通过搜索PubMed，Embase,和谷歌学者数据库，用于从成立到2023年12月31日发表的文章。这篇综述的目的是评估EBUS-TMC在纵隔疾病诊断中的应用。同时还使用QUADAS-2工具评估每项研究的质量。使用方差逆加权对诊断产量估计值进行荟萃分析。此外，对与该手术相关的并发症进行了全面分析.
结果：荟萃分析包括10项研究，共涉及538例患者。荟萃分析的结果表明，EBUS-TMC的总体诊断率为89.59％（482/538），而EBUS-TBNA的收益率为77.13%(415/538)。计算的逆方差加权比值比为2.63(95%置信区间，1.86-3.72；p<0.0001)，I2值为11%，表明两种技术之间存在统计学上的显著差异。相关的并发症包括气胸，纵隔肺炎，纵隔炎和出血，发病率为0.74%(4/538)，0.37%（2/538），0.0%（0/538），和1.12%（6/538），分别。此外，漏斗图显示没有明显的发表偏倚.进一步的亚组分析显示，淋巴瘤的诊断价值显着提高（86.36％vs.27.27%,p=0.0006）和良性疾病（87.62%vs.60.00%,p＜0.0001）。
结论：对现有研究的回顾表明，与EBUS-TBNA相比，EBUS-TMC提高了总体诊断率，特别是诊断良性疾病和淋巴瘤。此过程与任何严重并发症无关。
方法：通过搜索PubMed，Embase,和谷歌学者数据库，用于从成立到2023年12月31日发表的文章。这篇综述的目的是评估EBUS-TMC在纵隔疾病诊断中的应用。同时还使用QUADAS-2工具评估每项研究的质量。使用方差逆加权对诊断产量估计值进行荟萃分析。此外，对与该手术相关的并发症进行了全面分析.
结果：荟萃分析包括10项研究，共涉及538例患者。荟萃分析的结果表明，EBUS-TMC的总体诊断率为89.59％（482/538），而EBUS-TBNA的收益率为77.13%(415/538)。计算的逆方差加权比值比为2.63(95%置信区间，1.86-3.72；p<0.0001)，I2值为11%，表明两种技术之间存在统计学上的显著差异。相关的并发症包括气胸，纵隔肺炎，纵隔炎和出血，发病率为0.74%(4/538)，0.37%（2/538），0.0%（0/538），和1.12%（6/538），分别。此外，漏斗图显示没有明显的发表偏倚.进一步的亚组分析显示，淋巴瘤的诊断价值显着提高（86.36％vs.27.27%,p=0.0006）和良性疾病（87.62%vs.60.00%,p＜0.0001）。
结论：对现有研究的回顾表明，与EBUS-TBNA相比，EBUS-TMC提高了总体诊断率，特别是诊断良性疾病和淋巴瘤。此过程与任何严重并发症无关。
